Provider Demographics
NPI:1467908210
Name:HASSAN, AYAN S (LSW)
Entity Type:Individual
Prefix:
First Name:AYAN
Middle Name:S
Last Name:HASSAN
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3123 WAKESHIRE DR
Mailing Address - Street 2:3123 WAKESHIRE
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1740
Mailing Address - Country:US
Mailing Address - Phone:614-219-1992
Mailing Address - Fax:
Practice Address - Street 1:3123 WAKESHIRE DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017
Practice Address - Country:US
Practice Address - Phone:614-218-1992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS1600474101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health