Provider Demographics
NPI:1689210460
Name:EMERSON-GALLEGOS, ELIZABETH ERIN (MA, LMHCA, NCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ERIN
Last Name:EMERSON-GALLEGOS
Suffix:
Gender:F
Credentials:MA, LMHCA, NCC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1139 WESTMINSTER LN
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2838
Mailing Address - Country:US
Mailing Address - Phone:219-895-1628
Mailing Address - Fax:
Practice Address - Street 1:1139 WESTMINSTER LN
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2838
Practice Address - Country:US
Practice Address - Phone:219-895-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000365A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health