Provider Demographics
NPI:1770226003
Name:HANNA, MASON WARREN
Entity Type:Individual
Prefix:MR
First Name:MASON
Middle Name:WARREN
Last Name:HANNA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9156 ENTICING CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-3071
Mailing Address - Country:US
Mailing Address - Phone:702-906-3074
Mailing Address - Fax:
Practice Address - Street 1:7181 N HUALAPAI WAY STE 975
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89166-1115
Practice Address - Country:US
Practice Address - Phone:210-204-4585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-14
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician