Provider Demographics
NPI:1821416181
Name:GALLAGHER, DONALD (BCBA)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 SHAKER BLVD
Mailing Address - Street 2:SUITE 204 PMB 184
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:505-458-6602
Mailing Address - Fax:
Practice Address - Street 1:11811 SHAKER BLVD
Practice Address - Street 2:SUITE 204 PMB 184
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120
Practice Address - Country:US
Practice Address - Phone:505-458-6602
Practice Address - Fax:815-581-1005
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-14-15548103K00000X
OHCOBA.01247103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst