Individual
JACOB GALLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11120 S CROWN WAY STE 1, WELLINGTON, FL 33414-8718
(561) 790-1191
Mailing address
6559 BOUGAINVILLA AVE S, ST PETERSBURG, FL 33707-2318
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY10029
FL
Other
Enumeration date
06/19/2019
Last updated
06/19/2019
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