Provider Demographics
NPI:1063594158
Name:GALLOWAY, ELLEN HENLEY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:HENLEY
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 NORTH WAREHOUSE RD
Mailing Address - Street 2:USDB-DTP
Mailing Address - City:FT HOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66027
Mailing Address - Country:US
Mailing Address - Phone:913-758-3762
Mailing Address - Fax:913-758-3754
Practice Address - Street 1:1301 NORTH WAREHOUSE RD
Practice Address - Street 2:USDB-DTP
Practice Address - City:FT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027
Practice Address - Country:US
Practice Address - Phone:913-758-3751
Practice Address - Fax:913-758-3754
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical