Provider Demographics
NPI:1851840656
Name:GALLAS, JEREMY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:GALLAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 777117
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89077-7117
Mailing Address - Country:US
Mailing Address - Phone:702-824-9639
Mailing Address - Fax:725-214-3420
Practice Address - Street 1:2518 ANTHEM VILLAGE DR STE 103
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-5554
Practice Address - Country:US
Practice Address - Phone:702-824-9639
Practice Address - Fax:725-214-3420
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0790103TB0200X, 103TC2200X, 103TC0700X, 103TP2701X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy