Provider Demographics
NPI:1073708327
Name:GANZ, MANDY M (MA)
Entity Type:Individual
Prefix:MS
First Name:MANDY
Middle Name:M
Last Name:GANZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1478
Mailing Address - Street 2:
Mailing Address - City:SOLVANG
Mailing Address - State:CA
Mailing Address - Zip Code:93464-1478
Mailing Address - Country:US
Mailing Address - Phone:805-686-0295
Mailing Address - Fax:805-686-2856
Practice Address - Street 1:545 ALISAL RD
Practice Address - Street 2:#102
Practice Address - City:SOLVANG
Practice Address - State:CA
Practice Address - Zip Code:93463-2606
Practice Address - Country:US
Practice Address - Phone:805-688-6847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)