Provider Demographics
NPI:1457751208
Name:GALLAGHER, JOCELYN (CADC)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 HWY 45 N
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066
Mailing Address - Country:US
Mailing Address - Phone:270-247-4212
Mailing Address - Fax:270-247-2017
Practice Address - Street 1:1325 HWY 45 N
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066
Practice Address - Country:US
Practice Address - Phone:270-247-4212
Practice Address - Fax:270-247-2017
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1088101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)