Provider Demographics
NPI:1790015865
Name:GALARZA, ANIBAL JOHN (CADCII, CCJS, MBA)
Entity Type:Individual
Prefix:MR
First Name:ANIBAL
Middle Name:JOHN
Last Name:GALARZA
Suffix:
Gender:M
Credentials:CADCII, CCJS, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13957 SE 131ST AVE
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5232
Mailing Address - Country:US
Mailing Address - Phone:503-360-7375
Mailing Address - Fax:
Practice Address - Street 1:13957 SE 131ST AVE
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-4826
Practice Address - Country:US
Practice Address - Phone:503-360-7375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-12
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR415051000101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor