Provider Demographics
NPI:1053957407
Name:GALLEGOS, JILL MARIE (MS, LPCC)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:GALLEGOS
Suffix:
Gender:F
Credentials:MS, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5275 MARSHALL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3900
Mailing Address - Country:US
Mailing Address - Phone:303-596-8738
Mailing Address - Fax:
Practice Address - Street 1:5275 MARSHALL ST STE 101
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3900
Practice Address - Country:US
Practice Address - Phone:303-596-8738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-20
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0017192101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health