Provider Demographics
NPI:1740889484
Name:BAITY, HANNAH ELISE (MA, LCPC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ELISE
Last Name:BAITY
Suffix:
Gender:F
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:CLIFTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 155
Mailing Address - Street 2:
Mailing Address - City:CHRISTOPHER
Mailing Address - State:IL
Mailing Address - Zip Code:62822-0155
Mailing Address - Country:US
Mailing Address - Phone:618-724-2401
Mailing Address - Fax:618-724-4628
Practice Address - Street 1:165 KINNAMAN DR
Practice Address - Street 2:
Practice Address - City:FLORA
Practice Address - State:IL
Practice Address - Zip Code:62839-4204
Practice Address - Country:US
Practice Address - Phone:618-662-8386
Practice Address - Fax:618-662-4338
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-23
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178016091101YM0800X
IL180.014196101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL370912882Medicaid