Provider Demographics
NPI:1467281576
Name:CHISM, HANNAH (LPC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:CHISM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16332 HICKORY PINE LN APT B
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4830
Mailing Address - Country:US
Mailing Address - Phone:970-445-7469
Mailing Address - Fax:
Practice Address - Street 1:16332 HICKORY PINE LN APT B
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63011-4830
Practice Address - Country:US
Practice Address - Phone:970-445-7469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-29
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0020665101Y00000X
MO2024031898101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor