Provider Demographics
NPI:1407230741
Name:MACY GALLOWAY, TARA (MED, BCBA, BSL)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:MACY GALLOWAY
Suffix:
Gender:F
Credentials:MED, BCBA, BSL
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:MACY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 51322
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5622
Mailing Address - Country:US
Mailing Address - Phone:270-777-9283
Mailing Address - Fax:270-777-9283
Practice Address - Street 1:296 W RIDGE PIKE STE 205
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:PA
Practice Address - Zip Code:19468-1790
Practice Address - Country:US
Practice Address - Phone:610-831-1865
Practice Address - Fax:877-891-3208
Is Sole Proprietor?:No
Enumeration Date:2015-07-16
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001004103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst