Provider Demographics
NPI:1245937044
Name:GALLIANT NE LLC
Entity type:Organization
Organization Name:GALLIANT NE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-777-1331
Mailing Address - Street 1:6105 YELLOW ROSE CV
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1657
Mailing Address - Country:US
Mailing Address - Phone:972-777-1331
Mailing Address - Fax:
Practice Address - Street 1:20010 MANDERSON ST STE 104
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-1264
Practice Address - Country:US
Practice Address - Phone:972-777-1331
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALLIANT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-13
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty