Provider Demographics
NPI:1952655631
Name:GALLEGOS, KAY ELLEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:ELLEN
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 SAINT GEORGE LN STE 2
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1311
Mailing Address - Country:US
Mailing Address - Phone:530-403-7779
Mailing Address - Fax:530-718-3500
Practice Address - Street 1:2260 SAINT GEORGE LN STE 2
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1311
Practice Address - Country:US
Practice Address - Phone:530-403-7779
Practice Address - Fax:530-718-3500
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-02
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25137103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist