Samuel Adam Gallegos

Primary specialty

CounselorTaxonomy code 101Y00000X

Practice address

4 Avis Ave
Pueblo, CO 81005-3102

Phone

(719) 256-0127

Fax

(719) 258-1327

NPI assigned

Sep 12, 2022

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Impact Counseling Consulting LLC

  • Community/Behavioral Health Agency
  • Pueblo, CO
  • NPI 1366151730
  NPD

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662940800000",
    "number": "1730801259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 AVIS AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053102",
            "telephone_number": "719-256-0127",
            "fax_number": "719-258-1327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 AVIS AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810053102",
            "telephone_number": "719-256-0127",
            "fax_number": "719-258-1327"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GALLEGOS",
        "first_name": "SAMUEL",
        "middle_name": "ADAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-12",
        "last_updated": "2022-09-12",
        "certification_date": "2022-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elisa Gallegos
• Harley Gallegos
• Jennifer Leigh Gallegos, CNM
• Lucinda Ercellia Gallegos
• Rhiannon L Gallegos, RDH
• Sapphire Angel Gallegos
• Sarah Maria Gallegos, NP
• Tina Gallegos
• Venice Gallegos, M.A.
• Anne Galvin-Soto

• Counselor in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Counselor in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2022; 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.