Provider Demographics
NPI:1710023304
Name:GALLAGHER, CINDY KAY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:KAY
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5508 234TH ST SW
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-4746
Mailing Address - Country:US
Mailing Address - Phone:425-670-2320
Mailing Address - Fax:425-670-2526
Practice Address - Street 1:5508 234TH ST SW
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-4746
Practice Address - Country:US
Practice Address - Phone:425-670-2320
Practice Address - Fax:425-670-2526
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00005779101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health