Provider Demographics
NPI:1245382902
Name:GANZLER, HENRY NMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:NMI
Last Name:GANZLER
Suffix:
Gender:M
Credentials:PHD
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 358
Mailing Address - Street 2:
Mailing Address - City:FOREST RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95942
Mailing Address - Country:US
Mailing Address - Phone:530-891-0731
Mailing Address - Fax:
Practice Address - Street 1:2571 CALIFORNIA PARK DR
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-4042
Practice Address - Country:US
Practice Address - Phone:530-899-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3355103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical