Provider Demographics
NPI:1053705863
Name:GALLEGOS-CARR, JERRI (MED, MS, LMFT)
Entity type:Individual
Prefix:
First Name:JERRI
Middle Name:
Last Name:GALLEGOS-CARR
Suffix:
Gender:F
Credentials:MED, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7884 ROCKWIND CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1982
Mailing Address - Country:US
Mailing Address - Phone:702-979-0949
Mailing Address - Fax:
Practice Address - Street 1:8290 W SAHARA AVE
Practice Address - Street 2:SUITE 190
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-8931
Practice Address - Country:US
Practice Address - Phone:702-979-0949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV4100020226OtherDRIVERS LICENSE