Active NPI
Douglas R Gallup, LCPC
- Mental Health Counselor
- Pocatello, ID
National Provider Identifier
1891845913
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LCPC 3309
- Practice address
- 1169 Call Creek,Ste B
Pocatello, ID 83201 - Phone
- (208) 232-7780
- Fax
- (208) 232-7782
- NPI assigned
- Jan 11, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LCPC 3309 | ID | Primary |
Addresses
Primary practice location
1169 Call Creek,Ste B
Pocatello, ID 83201
Mailing address
1169 Call Creek
Pocatello, ID 83201
Phone (208) 232-7780
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCPC 3309 | ID | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168473600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891845913",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1169 CALL CREEK",
"city": "POCATELLO",
"state": "ID",
"postal_code": "83201",
"telephone_number": "208-232-7780",
"fax_number": "208-232-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1169 CALL CREEK,STE B",
"city": "POCATELLO",
"state": "ID",
"postal_code": "83201",
"telephone_number": "208-232-7780",
"fax_number": "208-232-7782"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GALLUP",
"first_name": "DOUGLAS",
"middle_name": "R",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "ID",
"license": "LCPC 3309",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pocatello, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.