Provider Demographics
NPI:1073651998
Name:GALLEGOS, JAMES (MFT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GALLEGOS
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3494 CAMINO TASSAJARA STE 1056
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4680
Mailing Address - Country:US
Mailing Address - Phone:925-383-3466
Mailing Address - Fax:
Practice Address - Street 1:16404 SMOKEY POINT BLVD STE 102B
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8417
Practice Address - Country:US
Practice Address - Phone:425-943-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61338799106H00000X
CA49883106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist