Provider Demographics
NPI:1063278067
Name:GALLAGHER, PAMELA M (LH 61400473)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:M
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LH 61400473
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S CEDAR ST APT 4
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3342
Mailing Address - Country:US
Mailing Address - Phone:425-279-3986
Mailing Address - Fax:
Practice Address - Street 1:717 S CEDAR ST APT 4
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3342
Practice Address - Country:US
Practice Address - Phone:425-279-3986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61400473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health