Provider Demographics
NPI:1871540914
Name:GALLINSON, MICK ALAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICK
Middle Name:ALAN
Last Name:GALLINSON
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:813 N CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3403
Mailing Address - Country:US
Mailing Address - Phone:323-463-4650
Mailing Address - Fax:
Practice Address - Street 1:360 N BEDFORD DR
Practice Address - Street 2:SUITE 219
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5129
Practice Address - Country:US
Practice Address - Phone:310-276-3636
Practice Address - Fax:310-288-0351
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 19451103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical