Healthcare Provider Details

I. General information

NPI: 1609584564
Provider Name (Legal Business Name): HANNAH MICHELE HODNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 12/07/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1404 S VIENNA ST
RUSTON LA
71270-6428
US

IV. Provider business mailing address

1404 S VIENNA ST
RUSTON LA
71270-6428
US

V. Phone/Fax

Practice location:
  • Phone: 318-224-9200
  • Fax:
Mailing address:
  • Phone: 318-224-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: