Provider Demographics
NPI:1457490948
Name:HANNA, PHYLLIS I (MA, LPC)
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:I
Last Name:HANNA
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8893 TAPPY TOORIE CIR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80129-2244
Mailing Address - Country:US
Mailing Address - Phone:303-791-7917
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR
Practice Address - Street 2:SUITE 360
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8063
Practice Address - Country:US
Practice Address - Phone:303-525-1331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional