Provider Demographics
NPI:1891434296
Name:CANEN, GABRIELLA G (LMFTA)
Entity Type:Individual
Prefix:
First Name:GABRIELLA
Middle Name:G
Last Name:CANEN
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62226 COUNTY ROAD 15
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-9438
Mailing Address - Country:US
Mailing Address - Phone:157-487-5511
Mailing Address - Fax:
Practice Address - Street 1:62226 COUNTY ROAD 15
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9438
Practice Address - Country:US
Practice Address - Phone:574-875-5117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85000409A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist