MEDICARE: DR. MICHAEL WALSH GANNON PH.D., L.C.A.D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	1520	TN
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	804748	CA

General Provider Information

NPI Number	:	1962809699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WALSH GANNON PH.D., L.C.A.D.C.

Provider Business Mailing Address
First Line	:	166 STURBRIDGE DR
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-3298
Country	:	US
Telephone Number	:	615-985-8255
Fax Number	:	615-985-8255

Provider Business Practice Location Address
First Line	:	1337 W MAIN ST
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37064-3732
Country	:	US
Telephone Number	:	615-985-8255
Fax Number	:	615-985-8255

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2014
Last Update Date	:	05/09/2026

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