Active NPI
Alyssa Gannon
- Counselor
- San Rafael, CA
National Provider Identifier
1871965178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 1401 Los Gamos Drive
Suite 240
San Rafael, CA 94903 - Phone
- (415) 457-1925
- NPI assigned
- Oct 26, 2015
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | Primary |
Addresses
Primary practice location
1401 Los Gamos Drive
Suite 240
San Rafael, CA 94903
Mailing address
1950 Matzen Ranch Circle
Petaluma, CA 94954
Phone (530) 524-2451
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Buckelew Programs | Past | Accepting new patients |
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.
-
- Community/Behavioral Health Agency
- Novato, CA
- NPI 1972993616
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1445817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1445817600000",
"number": "1871965178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 MATZEN RANCH CIRCLE",
"city": "PETALUMA",
"state": "CA",
"postal_code": "94954",
"telephone_number": "530-524-2451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1401 LOS GAMOS DRIVE",
"address_2": "SUITE 240",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "94903",
"telephone_number": "415-457-1925"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANNON",
"first_name": "ALYSSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-26",
"last_updated": "2015-10-26",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.