Provider Demographics
NPI:1801166970
Name:GALLAGHER, DEANNA LYNN (MARRIAGE & FAMILY TH)
Entity type:Individual
Prefix:MS
First Name:DEANNA
Middle Name:LYNN
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:MARRIAGE & FAMILY TH
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:LYNN
Other - Last Name:RUIZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARRIAGE & FAMILY TH
Mailing Address - Street 1:326 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6307
Mailing Address - Country:US
Mailing Address - Phone:909-455-3872
Mailing Address - Fax:909-455-3872
Practice Address - Street 1:326 E. CENTER STREET
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83202
Practice Address - Country:US
Practice Address - Phone:909-455-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5084253-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist