Provider Demographics
NPI:1861541229
Name:GALLAGHER, MICHAEL JOSEPH (LCSW, LCDC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:GALLAGHER
Suffix:
Gender:M
Credentials:LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DEVONSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-4210
Mailing Address - Country:US
Mailing Address - Phone:210-826-5319
Mailing Address - Fax:
Practice Address - Street 1:ALCOHOL TREATMENT CENTER
Practice Address - Street 2:121 COMBAT SUPPORT HOSPITAL
Practice Address - City:SEOUL
Practice Address - State:SOUTH KOREA
Practice Address - Zip Code:AP
Practice Address - Country:KR
Practice Address - Phone:737-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX163111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX16311OtherSOCIAL WORKER