Provider Demographics
NPI:1891487815
Name:NICOLE GANNON, LPC LLC
Entity Type:Organization
Organization Name:NICOLE GANNON, LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:412-256-8526
Mailing Address - Street 1:PO BOX 48
Mailing Address - Street 2:
Mailing Address - City:CURTISVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15032-0048
Mailing Address - Country:US
Mailing Address - Phone:412-256-8526
Mailing Address - Fax:
Practice Address - Street 1:12013 FRANKSTOWN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-3435
Practice Address - Country:US
Practice Address - Phone:412-256-8526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty