Provider Demographics
NPI:1396411484
Name:GANN, STACI BRIANNA (LPC-T)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:BRIANNA
Last Name:GANN
Suffix:
Gender:F
Credentials:LPC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: CFCC 1921 BARNES RD, MANHATTAN, KS, USA
Mailing Address - Street 2:KANSAS STATE UNIVERSITY
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-7249
Mailing Address - Country:US
Mailing Address - Phone:816-703-7899
Mailing Address - Fax:
Practice Address - Street 1:ATTN: CFCC 1921 BARNES RD, MANHATTAN, KS, USA
Practice Address - Street 2:KANSAS STATE UNIVERSITY
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-7249
Practice Address - Country:US
Practice Address - Phone:816-703-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03851-T101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor