Provider Demographics
NPI:1023634540
Name:SANOSSIAN-GAVIN, KNAR (PSYD)
Entity type:Individual
Prefix:DR
First Name:KNAR
Middle Name:
Last Name:SANOSSIAN-GAVIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1282 PALMER CIR
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-7742
Mailing Address - Country:US
Mailing Address - Phone:435-216-2140
Mailing Address - Fax:
Practice Address - Street 1:1282 PALMER CIR
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-7742
Practice Address - Country:US
Practice Address - Phone:435-216-2140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-20
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH329101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health