Provider Demographics
NPI:1346680121
Name:GANAS, KOREN (PSYD)
Entity Type:Individual
Prefix:
First Name:KOREN
Middle Name:
Last Name:GANAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KOREN
Other - Middle Name:
Other - Last Name:GANAS - WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3363
Mailing Address - Fax:812-450-3071
Practice Address - Street 1:415 W COLUMBIA ST STE 110
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1656
Practice Address - Country:US
Practice Address - Phone:812-450-6200
Practice Address - Fax:812-450-6202
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042694A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist