Grady Matthew Gallagher

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY1229 Issued in NV

Practice address

4021 Manning Mountain St
Las Vegas, NV 89129-3257

Phone

(202) 489-1403

NPI assigned

Apr 26, 2022

Last updated

Mar 4, 2026By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

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

• Gmgpsychology

  • Clinical Psychologist
  • Las Vegas, NV
  • NPI 1063221034
  NPD Authorized official

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

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1508500356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8414 FARM ROAD",
            "address_2": "STE 180 #1024",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891318007",
            "telephone_number": "202-489-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4021 MANNING MOUNTAIN ST",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891293257",
            "telephone_number": "202-489-1403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9930 O Loughlin Manor Ave",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891491299",
            "country_code": "US",
            "telephone_number": "202-489-1403",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GALLAGHER",
        "first_name": "GRADY",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-26",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NV",
            "license": "PY1229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin James Gall, PRSS
• Eric Arthur Galla, D.C.
• Alexis Brianna Gallagher
• Annemarie Elizabeth Gallagher, M.D.
• Elizabeth Marie Gallagher, RN
• Lindsey R Gallagher, RBT
• Lynda Gallagher
• Michelle Gallagher
• Timothy Michael Gallagher, M.D.
• Macybelen Palisoc Gallaher, FNP-BC

• Clinical Psychologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Clinical Psychologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.