Provider Demographics
NPI:1124338355
Name:GALLEGOS GAMEZ, CESAR G (MA, LPC)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:G
Last Name:GALLEGOS GAMEZ
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:CESAR
Other - Middle Name:G
Other - Last Name:GAMEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:39506 N DAISY MOUNTAIN DR STE 122160
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-6068
Mailing Address - Country:US
Mailing Address - Phone:800-782-4495
Mailing Address - Fax:
Practice Address - Street 1:2060 W WHISPERING WIND DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-2867
Practice Address - Country:US
Practice Address - Phone:800-782-4495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-13569101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional