Provider Demographics
NPI:1992489322
Name:HANNAH, AUSTIN LEE (LPC-IT)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:LEE
Last Name:HANNAH
Suffix:
Gender:M
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W2193 WILMERS GROVE RD
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120-2074
Mailing Address - Country:US
Mailing Address - Phone:262-379-4449
Mailing Address - Fax:
Practice Address - Street 1:2600 N MAYFAIR RD STE 400
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-1306
Practice Address - Country:US
Practice Address - Phone:414-939-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7465-226101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health