Provider Demographics
NPI:1588397434
Name:GALLO, SHAWN PATRICK (LISAC, CADAC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:GALLO
Suffix:
Gender:M
Credentials:LISAC, CADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5612
Mailing Address - Country:US
Mailing Address - Phone:602-932-5796
Mailing Address - Fax:
Practice Address - Street 1:1440 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5612
Practice Address - Country:US
Practice Address - Phone:602-932-5796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLISAC-11518101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)