Provider Demographics
NPI:1801325097
Name:GALLANT PSYCHOLOGICAL AND FORENSIC SERVICES, LLC
Entity type:Organization
Organization Name:GALLANT PSYCHOLOGICAL AND FORENSIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MILSPAW
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:717-763-4684
Mailing Address - Street 1:3803 CEDAR AVENUE
Mailing Address - Street 2:PO BOX 3303
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-763-4684
Mailing Address - Fax:717-737-7691
Practice Address - Street 1:PO BOX 3303
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-3303
Practice Address - Country:US
Practice Address - Phone:717-763-4684
Practice Address - Fax:717-737-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)