Provider Demographics
NPI:1902929078
Name:GALLAGHER, JAMIE ANNE (LMFT #111518)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:ANNE
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:LMFT #111518
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11533 C AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-2703
Mailing Address - Country:US
Mailing Address - Phone:530-889-7283
Mailing Address - Fax:530-889-7293
Practice Address - Street 1:11533 C AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-2703
Practice Address - Country:US
Practice Address - Phone:530-889-7283
Practice Address - Fax:530-889-7293
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111518106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist