Provider Demographics
NPI:1275002099
Name:HANAWA, EMI (LPC)
Entity Type:Individual
Prefix:
First Name:EMI
Middle Name:
Last Name:HANAWA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9239 SW 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-4733
Mailing Address - Country:US
Mailing Address - Phone:503-351-4932
Mailing Address - Fax:
Practice Address - Street 1:5331 SW MACADAM AVE STE 363
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3860
Practice Address - Country:US
Practice Address - Phone:503-351-4932
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4293101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health