Provider Demographics
NPI:1871045658
Name:GALLAGHER, MICHELLE (LPC, LISAC, CT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LPC, LISAC, CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13460 N 94TH DR
Mailing Address - Street 2:SUITE K-3
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4835
Mailing Address - Country:US
Mailing Address - Phone:623-974-3333
Mailing Address - Fax:623-974-3390
Practice Address - Street 1:8700 E VISTA BONITA DR
Practice Address - Street 2:SUITE 228
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-4251
Practice Address - Country:US
Practice Address - Phone:623-974-3333
Practice Address - Fax:623-974-3390
Is Sole Proprietor?:No
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-15937101Y00000X
AZLISAC-10174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)