Individual ProviderEthel GannonMarriage & Family TherapistBehavioral Health & Social Service ProvidersPractice Address11110 Los Alamitos Blvd Ste 213, Los Alamitos, CA 90720-3602(562) 325-3899PECOS EnrollmentBased on the most recent information from CMS, provider Ethel Gannon does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1528344504Provider TypeIndividualFull NameGannon, EthelGenderFemaleSole ProprietorYesEnumeration Date10/22/2011Last Updated10/22/2011Contact InformationPractice LocationPractice Address11110 Los Alamitos Blvd Ste 213, Los Alamitos, CA 90720-3602Phone(562) 325-3899FaxUnlisted FaxMailing LocationMailing Address13531 Raceland Rd, La Mirada, CA 90638-2929Phone(562) 325-3899FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode106H00000XPrimaryDescriptionMarriage & Family TherapistBehavioral Health & Social Service ProvidersLicenseMFC48157California