Doctor Name: | JAN GANANN |
NPI Number: | 1518297191 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | 104343 |
Business Practice Address: | 100 Old Sturgis Rd Ackerman, MS - 397356600 |
Business Phone Number: | 6622856225 |
Business Fax Number: | 6622856226 |
Mailing Address: | 302 N Jackson St, STARKVILLE |
State: | MS |
Postal Code: | 397592504 |
Phone Number: | 6623239261 |
Fax Number: | 6623249647 |
NPI Enumeration Date: | 01/05/2010 |
NPI Last Update Date: | 01/05/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 104343 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |