DR. MICHAEL WALSH GANNON PH.D. L.C.A.D.C. NPI 1962809699

NPI Information

NPI: 1962809699
Provider Name: DR. MICHAEL WALSH GANNON, PH.D., L.C.A.D.C.
Classification: Counselor - 101YA0400X
Entity Type: Individual

Specialization: Addiction (Substance Use Disorder)

Address:
109 CLOUD TOUCH CT
ROSEVILLE, CA
ZIP 95747
Phone: (916) 318-5317
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DR. Michael Walsh Gannon, PH.D., L.C.A.D.C. is an addiction (substance use disorder) counselor in Roseville, CA. DR. Michael Walsh Gannon, PH.D., L.C.A.D.C. NPI is 1962809699. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

109 CLOUD TOUCH CT
ROSEVILLE, CA
ZIP 95747-116
Phone: (916) 318-5317

The enumeration date for this NPI number is 11/24/2014 and was last updated on 11/18/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101YA0400X	Counselor	Addiction (Substance Use Disorder)	1340	KENTUCKY	No
2	101YA0400X	Counselor	Addiction (Substance Use Disorder)	167168	KENTUCKY	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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