Provider Demographics
NPI:1134673981
Name:GALLARDO, JANELLE NICOLE (MFT-I)
Entity type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:NICOLE
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:NICOLE
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1190 WILLITS DR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3842
Mailing Address - Country:US
Mailing Address - Phone:951-532-7108
Mailing Address - Fax:
Practice Address - Street 1:572 N ARROWHEAD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92401-1251
Practice Address - Country:US
Practice Address - Phone:909-266-2700
Practice Address - Fax:909-266-2710
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF92997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist