Provider Demographics
NPI:1174025290
Name:HANTON, MARK EDWARD (LPC, ED S)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EDWARD
Last Name:HANTON
Suffix:
Gender:M
Credentials:LPC, ED S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4884 WILLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:KIMBALL
Mailing Address - State:MI
Mailing Address - Zip Code:48074-1556
Mailing Address - Country:US
Mailing Address - Phone:810-650-2078
Mailing Address - Fax:
Practice Address - Street 1:1111 PINE GROVE AVE
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-3565
Practice Address - Country:US
Practice Address - Phone:810-650-2078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008066101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional