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General NPI Number Information
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NPI Number | 1194955427
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Entity Type | Individual
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Provider Name | SHANA REE GANN M.A.
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Gender | Female
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 1330 LINCOLN AVE
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City | SAN RAFAEL
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State | CA
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Zip | 94901-2120
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Country | US
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Telephone | 415-459-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 425 CALIFORNIA ST STE 1250
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City | SAN FRANCISCO
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State | CA
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Zip | 94104-2119
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Country | US
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Telephone | 415-857-3001
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 57236
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 52603
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License Number State | CA
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