Provider Demographics
NPI:1285109769
Name:GANIR, SHANETTA (LMFT-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:SHANETTA
Middle Name:
Last Name:GANIR
Suffix:
Gender:F
Credentials:LMFT-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12817 SARATOGA SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9439
Mailing Address - Country:US
Mailing Address - Phone:503-998-1494
Mailing Address - Fax:
Practice Address - Street 1:860 HEBRON PKWY STE 1102
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-5146
Practice Address - Country:US
Practice Address - Phone:817-406-7401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2018-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203232106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist