Healthcare Provider Details

I. General information

NPI: 1396284816
Provider Name (Legal Business Name): HANNAH CARR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 12/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W WESTERN AVE
AVONDALE AZ
85323-1848
US

IV. Provider business mailing address

3620 N. 3RD STREET
PHOENIX AZ
85012
US

V. Phone/Fax

Practice location:
  • Phone: 602-230-7373
  • Fax:
Mailing address:
  • Phone: 602-230-7373
  • Fax: 602-441-5836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16514
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: