Provider Demographics
NPI:1891508057
Name:GALEY, MARY BETH BERNELL (LP)
Entity type:Individual
Prefix:MRS
First Name:MARY BETH
Middle Name:BERNELL
Last Name:GALEY
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 EDEN PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-5808
Mailing Address - Country:US
Mailing Address - Phone:952-797-6131
Mailing Address - Fax:
Practice Address - Street 1:5710 EDEN PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-5808
Practice Address - Country:US
Practice Address - Phone:952-797-6131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3290103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling