Provider Demographics
NPI:1053875955
Name:GALLOUP, KRISTIN ELIZABETH (BA,RBT)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:GALLOUP
Suffix:
Gender:F
Credentials:BA,RBT
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ELIZABETH
Other - Last Name:BRETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA,RBT
Mailing Address - Street 1:PO BOX 1002
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-6002
Mailing Address - Country:US
Mailing Address - Phone:989-285-5029
Mailing Address - Fax:
Practice Address - Street 1:504 PINE AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1723
Practice Address - Country:US
Practice Address - Phone:989-285-9122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician