Provider Demographics
NPI:1679164156
Name:GALLASPY, CHARISS RENEE
Entity type:Individual
Prefix:
First Name:CHARISS
Middle Name:RENEE
Last Name:GALLASPY
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 1:301 E LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5644
Mailing Address - Country:US
Mailing Address - Phone:224-440-3858
Mailing Address - Fax:
Practice Address - Street 1:301 E LAKE DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-5644
Practice Address - Country:US
Practice Address - Phone:224-440-3858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty