Provider Demographics
NPI:1740240456
Name:GALLEGOS, BETH MI (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:BETH
Middle Name:MI
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:BETH
Other - Middle Name:MI
Other - Last Name:HODDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1404 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112
Mailing Address - Country:US
Mailing Address - Phone:641-781-0770
Mailing Address - Fax:626-795-7080
Practice Address - Street 1:807 4TH
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112
Practice Address - Country:US
Practice Address - Phone:641-781-0770
Practice Address - Fax:626-795-7080
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS184311041C0700X
CA184311041C0700X
IA0083681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical