Provider Demographics
NPI:1063438786
Name:GALLAS, STEWART LON (LPC)
Entity type:Individual
Prefix:
First Name:STEWART
Middle Name:LON
Last Name:GALLAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 W SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1938
Mailing Address - Country:US
Mailing Address - Phone:512-454-2847
Mailing Address - Fax:512-231-8488
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:BUILDING M, SUITE 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-349-2227
Practice Address - Fax:512-231-8488
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15917101YM0800X
TX16463104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker