Provider Demographics
NPI:1942350178
Name:GALLAGHER, JACALYN J (MA, MFT)
Entity Type:Individual
Prefix:
First Name:JACALYN
Middle Name:J
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:448 RIDGE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89501-1718
Mailing Address - Country:US
Mailing Address - Phone:775-772-3263
Mailing Address - Fax:775-324-1124
Practice Address - Street 1:448 RIDGE ST
Practice Address - Street 2:SUITE B
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1718
Practice Address - Country:US
Practice Address - Phone:775-772-3263
Practice Address - Fax:775-324-1124
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist