Provider Demographics
NPI:1790310514
Name:GALLMAN, MEGAN RUTHERFORD
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:RUTHERFORD
Last Name:GALLMAN
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 1:14673 MIDWAY RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3542
Mailing Address - Country:US
Mailing Address - Phone:469-324-9120
Mailing Address - Fax:
Practice Address - Street 1:14673 MIDWAY RD STE 107
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3542
Practice Address - Country:US
Practice Address - Phone:469-324-9120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health