Mark B Gallo Jr., LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

97597 Issued in CA

Practice address

1434 S Crescent Heights Blvd
Los Angeles, CA 90035-3857

Phone

(323) 864-9400

NPI assigned

Jan 10, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Premiere Therapy

  • Community/Behavioral Health Agency
  • Los Angeles, CA
  • NPI 1962091017
  NPD Authorized official
• Fusion Care Group, a Psychological Professional Corporation

  • Clinical Psychologist
  • Alpine, CA
  • NPI 1275177982
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610236800000",
    "number": "1326636853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1434 S CRESCENT HEIGHTS BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900353857",
            "telephone_number": "323-864-9400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1434 S CRESCENT HEIGHTS BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900353857",
            "telephone_number": "323-864-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLO",
        "first_name": "MARK",
        "middle_name": "B",
        "name_suffix": "Jr.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-01-10",
        "last_updated": "2021-01-10",
        "certification_date": "2021-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "97597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "markgallotherapy.com",
            "affiliation": "N",
            "endpointDescription": "domain",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1434 S Crescent Heights Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900353857",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cristina Gallo
• Danielle Kathy Gallo, RN
• Diane Jung Gallo, PSY.D.
• Helene Laura Gallo, LVN
• Jannely Gallo, MSW
• Matthew Christopher Gallo, MD
• Galloni Enterprises Medical Corporation
• Sarah Gallop, LMFT
• Dominique J Gallotta, LAC
• Davell D Galloway

• Marriage & Family Therapist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.