Provider Demographics
NPI:1215476882
Name:GALLAUGHER, KATHERINE (BCBA)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:GALLAUGHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 W BROADWAY APT 206
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-3686
Mailing Address - Country:US
Mailing Address - Phone:206-817-0805
Mailing Address - Fax:
Practice Address - Street 1:1717 E CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7024
Practice Address - Country:US
Practice Address - Phone:804-215-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-15
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6950103K00000X
VA0133003628103K00000X
WABA61249782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARBT-16-22316OtherBACB