Healthcare Provider Details

I. General information

NPI: 1427030089
Provider Name (Legal Business Name): MISTY M HANNAH M.A., L.P.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 12/01/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 E HIGH ST
WAYNESBURG PA
15370-1853
US

IV. Provider business mailing address

1453 KIRBY RD
WAYNESBURG PA
15370-3557
US

V. Phone/Fax

Practice location:
  • Phone: 724-833-1660
  • Fax:
Mailing address:
  • Phone: 724-833-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPC012496
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: