Individual
GAHAN FALLONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LP
Contact information
Practice address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5111
Mailing address
1300 E BRADFORD PKWY, SPRINGFIELD, MO 65804-4264
(417) 761-5000
(417) 761-5111
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2006004001
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669798575
—
MO
01
—
431560263
TRICARE
MO
01
—
P01089886
RR MCR
MO
Enumeration date
04/16/2010
Last updated
08/09/2022
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