Provider Demographics
NPI:1679789804
Name:ALLEN-MILLER, HANNAH KAY (LP)
Entity Type:Individual
Prefix:DR
First Name:HANNAH
Middle Name:KAY
Last Name:ALLEN-MILLER
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 RAYBROOK ST SE STE 203
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7717
Mailing Address - Country:US
Mailing Address - Phone:248-581-8777
Mailing Address - Fax:888-975-9374
Practice Address - Street 1:2020 RAYBROOK ST SE STE 203
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-7717
Practice Address - Country:US
Practice Address - Phone:248-581-8777
Practice Address - Fax:888-975-9374
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301016070103TC0700X
MI6301013349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1679789804Medicaid