Provider Demographics
NPI:1861737116
Name:GALLARDO, DEBRA (LPC)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33207 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-3423
Mailing Address - Country:US
Mailing Address - Phone:405-432-4132
Mailing Address - Fax:
Practice Address - Street 1:1303 W GORE BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-3645
Practice Address - Country:US
Practice Address - Phone:580-301-9519
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-27
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6002101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health