MEDICARE: MARK EDWARD HANTON L.P.C., ED. S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	6401008066	MI

General Provider Information

NPI Number	:	1174025290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK EDWARD HANTON L.P.C., ED. S.

Provider Business Mailing Address
First Line	:	4884 WILLINGTON AVE
Second Line	:
City	:	KIMBALL
State	:	MI
Zip	:	48074-1556
Country	:	US
Telephone Number	:	810-650-2078
Fax Number	:

Provider Business Practice Location Address
First Line	:	1111 PINE GROVE AVE
Second Line	:
City	:	PORT HURON
State	:	MI
Zip	:	48060-3565
Country	:	US
Telephone Number	:	810-650-2078
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	03/17/2018

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