Provider Demographics
NPI:1629830096
Name:GANSZ, ERIN AMANDA (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:AMANDA
Last Name:GANSZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2239 W 19TH ST
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3853
Mailing Address - Country:US
Mailing Address - Phone:505-859-1890
Mailing Address - Fax:
Practice Address - Street 1:2239 W 19TH ST
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3853
Practice Address - Country:US
Practice Address - Phone:505-859-1890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor