Provider Demographics
NPI:1063152544
Name:GANZ, ABBEY
Entity type:Individual
Prefix:
First Name:ABBEY
Middle Name:
Last Name:GANZ
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:P.O. BOX 854
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0854
Mailing Address - Country:US
Mailing Address - Phone:509-205-5559
Mailing Address - Fax:509-292-4155
Practice Address - Street 1:639 CULLUM AVE. STE 854
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-5048
Practice Address - Country:US
Practice Address - Phone:509-205-5559
Practice Address - Fax:509-292-4155
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-31
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health