Provider Demographics
NPI:1780327205
Name:LISA M. GALLAGHER LCPC, PLLC.
Entity type:Organization
Organization Name:LISA M. GALLAGHER LCPC, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:224-805-6817
Mailing Address - Street 1:3905 W NICHOLS RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1388
Mailing Address - Country:US
Mailing Address - Phone:224-805-6817
Mailing Address - Fax:
Practice Address - Street 1:738 E. DUNDEE ROAD
Practice Address - Street 2:SUITE 249
Practice Address - City:PALATINE
Practice Address - State:IL
Practice Address - Zip Code:60074
Practice Address - Country:US
Practice Address - Phone:224-805-6817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health