Provider Demographics
NPI:1053904060
Name:GALLAWAY, ASHLEY
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:GALLAWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17710 VILLAGE BROOKE DR W APT E
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7743
Mailing Address - Country:US
Mailing Address - Phone:317-480-6430
Mailing Address - Fax:
Practice Address - Street 1:1185 W CARMEL DR STE D4
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-8708
Practice Address - Country:US
Practice Address - Phone:317-569-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003891A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health