Provider Demographics
NPI:1912374190
Name:GALS INSTITUTE, LLC
Entity Type:Organization
Organization Name:GALS INSTITUTE, LLC
Other - Org Name:GALS WORSHOPS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MARINCIC
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:262-434-0540
Mailing Address - Street 1:383 WILLIAMSTOWNE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018
Mailing Address - Country:US
Mailing Address - Phone:262-337-9770
Mailing Address - Fax:262-337-9771
Practice Address - Street 1:383 WILLIAMSTOWNE
Practice Address - Street 2:SUITE 101
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018
Practice Address - Country:US
Practice Address - Phone:262-337-9770
Practice Address - Fax:262-337-9771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100011457Medicaid
WI1376612085OtherPERSONAL NPI NUMBER