Provider Demographics
NPI:1801405345
Name:HANNA, JASON J (LPC, SCL)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:J
Last Name:HANNA
Suffix:
Gender:M
Credentials:LPC, SCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 BIDDLE AVE APT P3
Mailing Address - Street 2:
Mailing Address - City:WYANDOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48192-6281
Mailing Address - Country:US
Mailing Address - Phone:734-552-4167
Mailing Address - Fax:
Practice Address - Street 1:3301 BIDDLE AVE APT P3
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-6281
Practice Address - Country:US
Practice Address - Phone:734-552-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401005885101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional