Healthcare Provider Details

I. General information

NPI: 1962809699
Provider Name (Legal Business Name): MICHAEL WALSH GANNON PH.D., L.C.A.D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2014
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1337 W MAIN ST
FRANKLIN TN
37064-3732
US

IV. Provider business mailing address

166 STURBRIDGE DR
FRANKLIN TN
37064-3298
US

V. Phone/Fax

Practice location:
  • Phone: 615-985-8255
  • Fax: 615-985-8255
Mailing address:
  • Phone: 615-985-8255
  • Fax: 615-985-8255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1520
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number804748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: