Provider Demographics
NPI:1285252304
Name:HANNA, MAX ANNA (MED LPC, LADC)
Entity type:Individual
Prefix:MRS
First Name:MAX ANNA
Middle Name:
Last Name:HANNA
Suffix:
Gender:F
Credentials:MED LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W. COFFEE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73025
Mailing Address - Country:US
Mailing Address - Phone:405-208-1973
Mailing Address - Fax:
Practice Address - Street 1:2600 W. COFFEE CREEK RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73025
Practice Address - Country:US
Practice Address - Phone:405-208-1973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1544101YM0800X
OK162101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty