Basic Information
| Provider Information | |||||||||
| NPI: | 1164627287 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GANN | ||||||||
| FirstName: | MELANIE | ||||||||
| MiddleName: | GAYLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPC-S | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHESSER | ||||||||
| OtherFirstName: | MELANIE | ||||||||
| OtherMiddleName: | GAYLE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MBS, LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1008 MERCURY DR | ||||||||
| Address2: | |||||||||
| City: | LAVON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751661870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5807954485 | ||||||||
| FaxNumber: | 5807957444 | ||||||||
| Practice Location | |||||||||
| Address1: | 7308 ALMA DR | ||||||||
| Address2: | |||||||||
| City: | PLANO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750253568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9724225939 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 10/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 67302 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.