Provider Demographics
NPI:1659705937
Name:GANN, WANDA KAY
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:KAY
Last Name:GANN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:KAY
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38835-0839
Mailing Address - Country:US
Mailing Address - Phone:662-286-9883
Mailing Address - Fax:662-284-9836
Practice Address - Street 1:1927A BRIAR RIDGE RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5963
Practice Address - Country:US
Practice Address - Phone:662-680-6250
Practice Address - Fax:662-680-4350
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health