Provider Demographics
NPI:1699838656
Name:GALLEGOS, JR., DANIEL J (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:GALLEGOS, JR.
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:P
Other - Last Name:GALLEGOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:1523 COLUMBIA DR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2634
Mailing Address - Country:US
Mailing Address - Phone:505-268-1661
Mailing Address - Fax:
Practice Address - Street 1:1523 COLUMBIA DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2634
Practice Address - Country:US
Practice Address - Phone:505-268-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0816103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling