Provider Demographics
NPI:1700521887
Name:HANOVER, EMILY LYNN
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:LYNN
Last Name:HANOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3017 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-8770
Mailing Address - Country:US
Mailing Address - Phone:254-415-1186
Mailing Address - Fax:
Practice Address - Street 1:311 E STAN SCHLUETER LOOP STE 208
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-6641
Practice Address - Country:US
Practice Address - Phone:254-539-5039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-03
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TXRBT-22-213969106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical