Provider Demographics
NPI:1992986939
Name:GALLE, MARY ANN (MA, LMHC, CRC)
Entity type:Individual
Prefix:MRS
First Name:MARY ANN
Middle Name:
Last Name:GALLE
Suffix:
Gender:F
Credentials:MA, LMHC, CRC
Other - Prefix:
Other - First Name:CONFIDENTIAL
Other - Middle Name:CHRISTIAN COUNSELING
Other - Last Name:CENTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6400 MANATEE AVE W
Mailing Address - Street 2:SUITE E
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-2378
Mailing Address - Country:US
Mailing Address - Phone:941-795-7986
Mailing Address - Fax:941-795-5333
Practice Address - Street 1:6400 MANATEE AVE W
Practice Address - Street 2:SUITE E
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-2378
Practice Address - Country:US
Practice Address - Phone:941-795-7986
Practice Address - Fax:941-795-5333
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 8473101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH 8473OtherST. OF FL. DEPT. OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE
042116OtherCOMMISSION OF REHABILITATION COUNSELING CERTIFICATION