Provider Demographics
NPI:1053348656
Name:GALLAGHER, LOU C (LCPC)
Entity type:Individual
Prefix:
First Name:LOU
Middle Name:C
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5263
Mailing Address - Country:US
Mailing Address - Phone:630-585-3920
Mailing Address - Fax:
Practice Address - Street 1:202 W WILLOW AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5263
Practice Address - Country:US
Practice Address - Phone:630-585-3920
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0002232424OtherBLUE SHIELD IL PRV #