Provider Demographics
NPI:1194404392
Name:GOLUB, GANNA LASKEN
Entity type:Individual
Prefix:
First Name:GANNA
Middle Name:LASKEN
Last Name:GOLUB
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:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:OREGON HOUSE
Mailing Address - State:CA
Mailing Address - Zip Code:95962-0855
Mailing Address - Country:US
Mailing Address - Phone:530-812-6186
Mailing Address - Fax:
Practice Address - Street 1:12659 RICES CROSSING RD
Practice Address - Street 2:
Practice Address - City:OREGON HOUSE
Practice Address - State:CA
Practice Address - Zip Code:95962
Practice Address - Country:US
Practice Address - Phone:530-812-6186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist