Healthcare Provider Details

I. General information

NPI: 1205433307
Provider Name (Legal Business Name): LIANNE GANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2020
Last Update Date: 10/02/2020
Certification Date: 10/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246-3057
US

IV. Provider business mailing address

4100 E MISSISSIPPI AVE STE 1300
DENVER CO
80246-3057
US

V. Phone/Fax

Practice location:
  • Phone: 303-771-0861
  • Fax:
Mailing address:
  • Phone: 303-771-0861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY.0005324
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: