Healthcare Provider Details

I. General information

NPI: 1740889484
Provider Name (Legal Business Name): HANNAH ELISE BAITY MA, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: HANNAH CLIFTON

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 KINNAMAN DR
FLORA IL
62839-4204
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-8386
  • Fax: 618-662-4338
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178016091
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.014196
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: