Provider Demographics
NPI:1528764982
Name:GANGNON, KELSEY NICOLE (LMHCA)
Entity type:Individual
Prefix:MRS
First Name:KELSEY
Middle Name:NICOLE
Last Name:GANGNON
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:MISS
Other - First Name:KELSEY
Other - Middle Name:NICOLE
Other - Last Name:SCHRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHCA
Mailing Address - Street 1:8590 ROSES RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3439
Mailing Address - Country:US
Mailing Address - Phone:317-496-4696
Mailing Address - Fax:
Practice Address - Street 1:9135 N MERIDIAN ST STE C5
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1817
Practice Address - Country:US
Practice Address - Phone:317-533-0329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001558A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health