Provider Demographics
NPI:1306016498
Name:HANNEMANN, LLOYD BURTON (MA MFT)
Entity Type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:BURTON
Last Name:HANNEMANN
Suffix:
Gender:M
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 216
Mailing Address - Street 2:
Mailing Address - City:MALO
Mailing Address - State:WA
Mailing Address - Zip Code:99150-0216
Mailing Address - Country:US
Mailing Address - Phone:509-634-2611
Mailing Address - Fax:509-634-2781
Practice Address - Street 1:1 COLVILLE ST
Practice Address - Street 2:
Practice Address - City:NESPELEM
Practice Address - State:WA
Practice Address - Zip Code:99155-0150
Practice Address - Country:US
Practice Address - Phone:509-634-2611
Practice Address - Fax:509-634-2781
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC00026985101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1980812Medicaid