Provider Demographics
NPI:1053550772
Name:GALLEGO, GLORIA (LMFT)
Entity type:Individual
Prefix:MS
First Name:GLORIA
Middle Name:
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:LMFT
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 3742
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-0742
Mailing Address - Country:US
Mailing Address - Phone:626-282-4170
Mailing Address - Fax:
Practice Address - Street 1:1215 S HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2850
Practice Address - Country:US
Practice Address - Phone:909-622-2824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist