Provider Demographics
NPI:1780446898
Name:GALLEGOS, CASSIDY TAYLOR
Entity type:Individual
Prefix:
First Name:CASSIDY
Middle Name:TAYLOR
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3143 VALLEJO ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3818
Mailing Address - Country:US
Mailing Address - Phone:925-255-3686
Mailing Address - Fax:
Practice Address - Street 1:2442 S DOWNING ST STE 250
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-5858
Practice Address - Country:US
Practice Address - Phone:720-295-4273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0021627101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional