Individual
JOHN GALLAGHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
415 E MADISON ST, SOUTH BEND, IN 46617-2322
(574) 283-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
87001365A
IN
104100000X
Social Worker
Primary
33006220A
IN
Other
Enumeration date
12/24/2007
Last updated
11/29/2012
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