Active NPI
Christine M. Gannon, LCSW
- Clinical Social Worker
- Yreka, CA
National Provider Identifier
1265608632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- LCSW81120
- Practice address
- 2060 Campus Dr
Yreka, CA 96097-9538 - Phone
- (530) 841-4848
- NPI assigned
- May 5, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW81120 | CA | Primary |
| Counselor | 101Y00000X | ASW61631 | CA |
Addresses
Primary practice location
2060 Campus Dr
Yreka, CA 96097-9538
Mailing address
2060 Campus Dr.
Children'S System of Care
Yreka, CA 96097
Phone (530) 841-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ASW61631 | CA | MD | Counselor |
| LCSW81120 | CA | MD | Clinical Social Worker |
| 81120 | CA | MD | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1209945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1265608632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2060 CAMPUS DR.",
"address_2": "CHILDREN'S SYSTEM OF CARE",
"city": "YREKA",
"state": "CA",
"postal_code": "96097",
"telephone_number": "530-841-4100",
"fax_number": "530-841-4799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2060 CAMPUS DR",
"city": "YREKA",
"state": "CA",
"postal_code": "960979538",
"telephone_number": "530-841-4848"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "CHRISTINE",
"middle_name": "M.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-05-05",
"last_updated": "2024-09-23",
"certification_date": "2024-09-16",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "LCSW81120",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "CA",
"license": "ASW61631",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Yreka, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.