Amanda Paulette Gannon, LMSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

215055 Issued in AK

Practice address

344 Front St Ste a
Ketchikan, AK 99901-6431

Phone

(572) 999-0107

NPI assigned

Oct 27, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Be Well Counseling LLC

  • Community/Behavioral Health Agency
  • Ketchikan, AK
  • NPI 1215695416
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603756800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722470400000",
    "number": "1285234419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 519",
            "city": "WARD COVE",
            "state": "AK",
            "postal_code": "999280519",
            "telephone_number": "907-204-0874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 FRONT ST STE A",
            "city": "KETCHIKAN",
            "state": "AK",
            "postal_code": "999016431",
            "telephone_number": "572-999-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANNON",
        "first_name": "AMANDA",
        "middle_name": "PAULETTE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-27",
        "last_updated": "2024-08-01",
        "certification_date": "2024-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "AK",
            "license": "215055",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "AK",
            "license": "215055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366719759",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dayana Funez Martinez
• Samantha Funk, LPC
• Christine Marie Furey, CDC-T
• Lonna Gabbard
• Neil Gabbart
• Bradley Gao, MD
• Maria Garcia Vasquez
• David Garcia, MA
• Patricia Gardner
• Emerald Garza

• Mental Health Counselor in Ketchikan, AK
• Providers in Ketchikan, AK by specialty
• Mental Health Counselor in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 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.

Verify at the official NPI Registry.