Provider Demographics
NPI:1033794169
Name:JASON GALLANT, PH.D., LLC
Entity type:Organization
Organization Name:JASON GALLANT, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL ALAN
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:407-588-2190
Mailing Address - Street 1:5550 GLADES RD STE 650
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7257
Mailing Address - Country:US
Mailing Address - Phone:561-880-4225
Mailing Address - Fax:
Practice Address - Street 1:5550 GLADES RD STE 650
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7257
Practice Address - Country:US
Practice Address - Phone:561-880-4225
Practice Address - Fax:561-880-4462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-10
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty