1053257964 NPI number — NICOLE THERESE GANTNEY ASW, MSW, PPSC

Table of content: NICOLE THERESE GANTNEY ASW, MSW, PPSC (NPI 1053257964)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053257964 NPI number — NICOLE THERESE GANTNEY ASW, MSW, PPSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GANTNEY
Provider First Name:
NICOLE
Provider Middle Name:
THERESE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ASW, MSW, PPSC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GANTNEY
Provider Other First Name:
NIKKI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ASW, MSW, PPSC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053257964
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 HARRIS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95503-4448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-441-2051
Provider Business Mailing Address Fax Number:
707-445-6124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
624 HARRIS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95503-4448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-441-2051
Provider Business Practice Location Address Fax Number:
707-445-6124
Provider Enumeration Date:
04/24/2026

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  379038 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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