Provider Demographics
NPI:1851531453
Name:GALLARDO, ANNETTE (PHD, LPC-MHSP)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:PHD, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 MAXWELL ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5365
Mailing Address - Country:US
Mailing Address - Phone:931-310-0334
Mailing Address - Fax:931-372-0893
Practice Address - Street 1:1437 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-1439
Practice Address - Country:US
Practice Address - Phone:931-372-9915
Practice Address - Fax:931-372-0893
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-23
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health