Provider Demographics
NPI:1770906356
Name:GALLE, SANDRA JEAN (LCSW/LICSW)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:JEAN
Last Name:GALLE
Suffix:
Gender:F
Credentials:LCSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3089
Mailing Address - Street 2:CENTER FOR MENTAL HEALTH
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-3089
Mailing Address - Country:US
Mailing Address - Phone:406-443-7151
Mailing Address - Fax:406-791-9629
Practice Address - Street 1:900 JACKSON ST
Practice Address - Street 2:CENTER FOR MENTAL HEALTH
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3428
Practice Address - Country:US
Practice Address - Phone:406-443-7151
Practice Address - Fax:406-791-9629
Is Sole Proprietor?:No
Enumeration Date:2014-02-01
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW603088151041C0700X
MTSWP-LCSW-LIC-47301041C0700X
DCLC500797501041C0700X
VA09040083791041C0700X
WYLCSW-8811041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0MT0703063OtherBLUE CROSS-SHIELD OF MONTANA
MT0MT0703063OtherBLUE CROSS-SHIELD OF MONTANA