Provider Demographics
NPI:1528420775
Name:ADA M. GALLUP COUNSELING
Entity type:Organization
Organization Name:ADA M. GALLUP COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ADA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLUP
Authorized Official - Suffix:
Authorized Official - Credentials:PLPC
Authorized Official - Phone:573-239-6642
Mailing Address - Street 1:202 AMANDA DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65010-1201
Mailing Address - Country:US
Mailing Address - Phone:573-239-6642
Mailing Address - Fax:
Practice Address - Street 1:202 AMANDA DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:MO
Practice Address - Zip Code:65010-1201
Practice Address - Country:US
Practice Address - Phone:573-239-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-27
Last Update Date:2016-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016008293251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health