Provider Demographics
NPI:1215353313
Name:HASENOHRL, AMELIA (MA, LPC, CHT)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:HASENOHRL
Suffix:
Gender:F
Credentials:MA, LPC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2135
Mailing Address - Country:US
Mailing Address - Phone:231-935-0388
Mailing Address - Fax:231-935-0941
Practice Address - Street 1:1105 SIXTH ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2349
Practice Address - Country:US
Practice Address - Phone:231-935-0388
Practice Address - Fax:231-935-0941
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401002029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional