Provider Demographics
NPI:1013376045
Name:GUPTON, HANNAH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:GUPTON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:GRACE
Other - Last Name:RIDDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 REVERE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1566
Mailing Address - Country:US
Mailing Address - Phone:847-291-6805
Mailing Address - Fax:
Practice Address - Street 1:5 REVERE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1566
Practice Address - Country:US
Practice Address - Phone:847-291-6805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.010987101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional