Provider Demographics
NPI:1982767794
Name:HANNAH, MICHAEL BAKER (MS LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BAKER
Last Name:HANNAH
Suffix:
Gender:M
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MOSS ROSE LN
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-5775
Mailing Address - Country:US
Mailing Address - Phone:214-236-0780
Mailing Address - Fax:512-722-3587
Practice Address - Street 1:500 MOSS ROSE LN
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-5775
Practice Address - Country:US
Practice Address - Phone:214-236-0780
Practice Address - Fax:214-361-2900
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health