Provider Demographics
NPI:1235019332
Name:GALLUP, BETH G (MA, MS, NCSP)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:G
Last Name:GALLUP
Suffix:
Gender:F
Credentials:MA, MS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 BOBWHITE CT
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-9443
Mailing Address - Country:US
Mailing Address - Phone:301-431-5630
Mailing Address - Fax:
Practice Address - Street 1:8908 RIGGS RD
Practice Address - Street 2:
Practice Address - City:ADELPHI
Practice Address - State:MD
Practice Address - Zip Code:20783-1632
Practice Address - Country:US
Practice Address - Phone:301-431-5606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDCER-171249-F3R7N3103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist