Provider Demographics
NPI:1326858218
Name:GANNON COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:GANNON COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, ACS, CCS
Authorized Official - Phone:201-688-0157
Mailing Address - Street 1:301 CONSTITUTION AVE APT 451
Mailing Address - Street 2:
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-6004
Mailing Address - Country:US
Mailing Address - Phone:201-688-0157
Mailing Address - Fax:
Practice Address - Street 1:301 CONSTITUTION AVE APT 451
Practice Address - Street 2:
Practice Address - City:BAYONNE
Practice Address - State:NJ
Practice Address - Zip Code:07002-6004
Practice Address - Country:US
Practice Address - Phone:201-688-0157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty