Provider Demographics
NPI:1508658105
Name:GALUSHA, GABE JASON (RBT)
Entity type:Individual
Prefix:
First Name:GABE
Middle Name:JASON
Last Name:GALUSHA
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:GABRIEL
Other - Middle Name:JASON
Other - Last Name:GALUSHA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RBT
Mailing Address - Street 1:620 OLD RAILROAD BED RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-6224
Mailing Address - Country:US
Mailing Address - Phone:931-993-9345
Mailing Address - Fax:
Practice Address - Street 1:620 OLD RAILROAD BED RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-6224
Practice Address - Country:US
Practice Address - Phone:931-993-9345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN106S00000X
AL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician