Provider Demographics
NPI:1013986561
Name:GALLAGHER, ROSLYN MARY (LCPC)
Entity Type:Individual
Prefix:
First Name:ROSLYN
Middle Name:MARY
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 2ND ST S STE 20
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3600
Mailing Address - Country:US
Mailing Address - Phone:406-899-0865
Mailing Address - Fax:
Practice Address - Street 1:104-2ND STREET S., STE. 20
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3600
Practice Address - Country:US
Practice Address - Phone:406-899-0865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT757 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000075378OtherBLUE CROSS/SHIELD OF MONT