Provider Demographics
NPI:1851640841
Name:GALLAGHER, MICHAEL R (LMLP, LCPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:LMLP, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9763 E STATE LINE RD
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61019-9751
Mailing Address - Country:US
Mailing Address - Phone:815-291-0748
Mailing Address - Fax:
Practice Address - Street 1:416 N CENTER ST
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:IL
Practice Address - Zip Code:61024
Practice Address - Country:US
Practice Address - Phone:815-248-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2580103T00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist