Provider Demographics
NPI:1215917455
Name:GALLAN, ARLENE GEORGIA (PHD)
Entity type:Individual
Prefix:
First Name:ARLENE
Middle Name:GEORGIA
Last Name:GALLAN
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 1:1601 CARMEN DR STE 211
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-3103
Mailing Address - Country:US
Mailing Address - Phone:910-431-2388
Mailing Address - Fax:
Practice Address - Street 1:1601 CARMEN DR STE 211
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-3103
Practice Address - Country:US
Practice Address - Phone:910-431-2388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-21
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3018103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6008371Medicaid
NCDR1788OtherRR MEDICARE
NC459622OtherMHN/TRICARE PRIME
NCP00978895OtherRR MEDICARE
NC6000529Medicaid
NC459622OtherMHN/TRICARE PRIME
NC2492770BMedicare PIN