Individual provider Active NPI

Gabrielle Monson Hannon, LAMFT

  • Marriage & Family Therapist
  • Ammon, ID
National Provider Identifier
1356088934
Registry record updated Mar 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
LAMFT-8874 Issued in ID
Practice address
3522 Briar Creek LN
Ammon, ID 83406-4728
Phone
(208) 529-1660
Fax
(208) 529-1699
NPI assigned
May 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X LAMFT-8874 ID Primary

Addresses

Primary practice location

3522 Briar Creek LN
Ammon, ID 83406-4728

Mailing address

PO Box 3858
Idaho Falls, ID 83403-3858
Phone (208) 529-1660

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260505001712 ID Practitioner - Marriage and Family Therapist 2769950120 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Marriage and Family Therapist
Education
Other, 2020
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1240 Alameda Ave
Idaho Falls, ID 83401-2153

1908 Jennie Lee Dr
Idaho Falls, ID 83404-6159

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LAMFT-8874IDMDMarriage & Family Therapist

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678924800000",
    "number": "1356088934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3858",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834033858",
            "telephone_number": "208-529-1660",
            "fax_number": "208-529-1699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3522 BRIAR CREEK LN",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064728",
            "telephone_number": "208-529-1660",
            "fax_number": "208-529-1699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANNON",
        "first_name": "GABRIELLE",
        "middle_name": "MONSON",
        "credential": "LAMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-16",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "ID",
            "license": "LAMFT-8874",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ammon, ID

Sources for this page

Verify at the official NPI Registry.