Provider Demographics
NPI:1053694794
Name:GANS, ALLISON GALE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:GALE
Last Name:GANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 FILLMORE ST APT 101
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2123
Mailing Address - Country:US
Mailing Address - Phone:734-717-4720
Mailing Address - Fax:
Practice Address - Street 1:14429 CATALINA ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5515
Practice Address - Country:US
Practice Address - Phone:510-351-3665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist