Provider Demographics
NPI:1720297625
Name:GALBERTH, NICOLE R (MS)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:R
Last Name:GALBERTH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 SE CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97080-8065
Mailing Address - Country:US
Mailing Address - Phone:971-678-8226
Mailing Address - Fax:
Practice Address - Street 1:320 N MAIN AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-7242
Practice Address - Country:US
Practice Address - Phone:971-678-8226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC3131101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health