Provider Demographics
NPI:1023279452
Name:GALLAGHER, JAN AGERS (LMHC)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:AGERS
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JAN
Other - Middle Name:ELIZABETH
Other - Last Name:AGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4741 ATLANTIC BLVD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-1114
Mailing Address - Country:US
Mailing Address - Phone:904-398-1918
Mailing Address - Fax:904-396-6001
Practice Address - Street 1:4741 ATLANTIC BLVD
Practice Address - Street 2:SUITE B-3
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-1114
Practice Address - Country:US
Practice Address - Phone:904-398-1918
Practice Address - Fax:904-396-6001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH0002177101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3778OtherBCBS OF FL