Active NPI
Ethel Gannon
- Marriage & Family Therapist
- Los Alamitos, CA
National Provider Identifier
1528344504
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC48157
- Practice address
- 11110 Los Alamitos Blvd Ste 213
Los Alamitos, CA 90720-3602 - Phone
- (562) 325-3899
- NPI assigned
- Oct 22, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC48157 | CA | Primary |
Addresses
Primary practice location
11110 Los Alamitos Blvd Ste 213
Los Alamitos, CA 90720-3602
Mailing address
13531 Raceland Rd
La Mirada, CA 90638-2929
Phone (562) 325-3899
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC48157 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319241600000",
"number": "1528344504",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13531 RACELAND RD",
"city": "LA MIRADA",
"state": "CA",
"postal_code": "906382929",
"telephone_number": "562-325-3899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11110 LOS ALAMITOS BLVD STE 213",
"city": "LOS ALAMITOS",
"state": "CA",
"postal_code": "907203602",
"telephone_number": "562-325-3899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "ETHEL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-22",
"last_updated": "2011-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC48157",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Alamitos, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.