Provider Demographics
NPI:1013315910
Name:GALLOP, VICTORIA FRANCES (LPCC)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:FRANCES
Last Name:GALLOP
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:FRANCES
Other - Last Name:FRAZIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 W GRIGGS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1234
Mailing Address - Country:US
Mailing Address - Phone:575-647-2800
Mailing Address - Fax:575-647-2898
Practice Address - Street 1:315 S HUDSON ST
Practice Address - Street 2:SUITE 6
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-6184
Practice Address - Country:US
Practice Address - Phone:575-388-4412
Practice Address - Fax:575-534-1170
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0130681101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM18677037Medicaid