Provider Demographics
NPI:1255066247
Name:GALLARDO, JOSEPH ALBERT (LISAC)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALBERT
Last Name:GALLARDO
Suffix:
Gender:M
Credentials:LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 S GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-3010
Mailing Address - Country:US
Mailing Address - Phone:520-831-3560
Mailing Address - Fax:
Practice Address - Street 1:144 S GRANDE AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-3010
Practice Address - Country:US
Practice Address - Phone:520-831-3560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)