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General NPI Number Information
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NPI Number | 1396278925
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Entity Type | Organization
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Legal Business Name | MICHELLE GANSS, LMSW, LLC
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Dates
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Enumeration Date | 04/11/2017
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 50 FILER ST SUITE 210F
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City | MANISTEE
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State | MI
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Zip | 49660-2726
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Country | US
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Telephone | 231-299-7507
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Fax |
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Provider Business Mailing Address
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Address Line | 1519 LAKESHORE RD
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City | MANISTEE
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State | MI
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Zip | 49660-1038
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Country | US
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Telephone | 231-233-9563
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHELLE RENEE GANSS
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Credential | LMSW
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Telephone | 231-299-7507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801090644
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License Number State | MI
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