Provider Demographics
NPI:1699452318
Name:MIRACLE, HANNAH ROBERTSON
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:ROBERTSON
Last Name:MIRACLE
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 1:1464 QUEBEC WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-6580
Mailing Address - Country:US
Mailing Address - Phone:859-324-2845
Mailing Address - Fax:
Practice Address - Street 1:1621 SCOTTSVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3244
Practice Address - Country:US
Practice Address - Phone:270-746-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-04
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health