Healthcare Provider Details

I. General information

NPI: 1629983895
Provider Name (Legal Business Name): HANNAH DEATZ MS, LPC, CSAT-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2049 S BRENTWOOD BLVD
SPRINGFIELD MO
65804-2536
US

IV. Provider business mailing address

1924 S WESTWOOD AVE
SPRINGFIELD MO
65807-2321
US

V. Phone/Fax

Practice location:
  • Phone: 660-253-0856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026011034
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: