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General NPI Number Information
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NPI Number | 1326858218
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Entity Type | Organization
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Legal Business Name | GANNON COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 01/13/2025
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Last Update Date | 01/13/2025
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Provider Practice Location Address
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Address Line | 301 CONSTITUTION AVE APT 451
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City | BAYONNE
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State | NJ
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Zip | 07002-6004
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Country | US
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Telephone | 201-688-0157
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Fax |
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Provider Business Mailing Address
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Address Line | 301 CONSTITUTION AVE APT 451
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City | BAYONNE
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State | NJ
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Zip | 07002-6004
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Country | US
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Telephone | 201-688-0157
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | ELLYN LEIBOWITZ
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Credential | MA, LPC, ACS, CCS
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Telephone | 201-688-0157
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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