Provider Demographics
NPI:1235627019
Name:HANAFIN, MICHAEL JOSEPH JR (LAC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:HANAFIN
Suffix:JR
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15455 N GREENWAY HAYDEN LOOP STE C9
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-1887
Mailing Address - Country:US
Mailing Address - Phone:480-681-4322
Mailing Address - Fax:480-447-9564
Practice Address - Street 1:15455 N GREENWAY HAYDEN LOOP STE C9
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-1887
Practice Address - Country:US
Practice Address - Phone:480-681-4322
Practice Address - Fax:480-447-9564
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16444101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty