Provider Demographics
NPI:1154589794
Name:GALLEGO, KARI (MA)
Entity type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:GALLEGO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5481
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-0009
Mailing Address - Country:US
Mailing Address - Phone:916-985-8762
Mailing Address - Fax:
Practice Address - Street 1:1665 CREEKSIDE DR STE 106
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3538
Practice Address - Country:US
Practice Address - Phone:916-985-8762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38089106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist