MR. BRADLEY A GANGNON LADC, ADCR-MN CPRS
NPI 1225715097
Counselor - Addiction (Substance Use Disorder) in Minneapolis, MN
Active since July 03, 2023
About Mr. Bradley A Gangnon Ladc, Adcr-mn Cprs NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. BRADLEY A GANGNON LADC, ADCR-MN CPRS (NPI 1225715097) is an individual addiction (substance use disorder) provider in Minneapolis, Minnesota, licensed in Minnesota (305379) and active in the NPI registry since July 2023.
NPPES Registry Identity
NPI1225715097
Entity TypeIndividualMale
Primary Taxonomy101YA0400X
Provider Legal NameMR. BRADLEY A GANGNONCredential: LADC, ADCR-MN CPRS
Location Address1516 W LAKE ST # 205Minneapolis, MN 55408-2554
Mailing Address1516 W Lake St # 205Minneapolis, MN 55408-2554 · (612) 297-1804
Phone(612) 297-1804
Sole ProprietorNo
Enumeration DateJuly 3, 2023
NPPES CertifiedApril 10, 2022
✔ NPI 1225715097 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyCounselor · Addiction (Substance Use Disorder)Behavioral Health & Social Service Providers
Taxonomy Code101YA0400X
License✔ Licensed in MN · 305379
Also ListedRehabilitation PractitionerTaxonomy 225400000X · License 10053940
1516 W LAKE ST # 205, Minneapolis, MN 55408
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1225715097, enumerated as an "individual" on July 03, 2023.
The provider is located at 1516 W LAKE ST # 205 MINNEAPOLIS, MN 55408 and the phone number is (612) 297-1804.
Counselor with taxonomy code 101YA0400X and a focus in Addiction (Substance Use Disorder).
