Provider Demographics
NPI:1619086535
Name:HANNA, ETHEL B (MFT)
Entity Type:Individual
Prefix:DR
First Name:ETHEL
Middle Name:B
Last Name:HANNA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12872 VALLEY VIEW
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92845
Mailing Address - Country:US
Mailing Address - Phone:714-995-1223
Mailing Address - Fax:714-995-3636
Practice Address - Street 1:12872 VALLEY VIEW
Practice Address - Street 2:SUITE 7
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92845
Practice Address - Country:US
Practice Address - Phone:714-995-1223
Practice Address - Fax:714-995-3636
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT7648101Y00000X, 101YA0400X, 101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health