Provider Demographics
NPI:1003155482
Name:HANNEMANN, JUSTIN LEE (LIMHP)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:LEE
Last Name:HANNEMANN
Suffix:
Gender:M
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-1559
Mailing Address - Country:US
Mailing Address - Phone:402-913-4999
Mailing Address - Fax:
Practice Address - Street 1:1510 Q ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68508-1647
Practice Address - Country:US
Practice Address - Phone:402-913-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist