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NPI Code Detail

MEDICARE: MRS. KELSEY NICOLE GANGNON LMHCA

MEDICARE: MRS. KELSEY NICOLE GANGNON LMHCA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor88001558AIN

General Provider Information

NPI Number : 1528764982
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELSEY NICOLE GANGNON LMHCA
Provider Business Mailing Address
First Line : 8590 ROSES RD
Second Line :
City : FISHERS
State : IN
Zip : 46038-3439
Country : US
Telephone Number : 317-496-4696
Fax Number :
Provider Business Practice Location Address
First Line : 9135 N MERIDIAN ST STE C5
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1817
Country : US
Telephone Number : 317-533-0329
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2023
Last Update Date : 02/06/2023

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Directions to “ MRS. KELSEY NICOLE GANGNON LMHCA” Practice Location

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