=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588282198
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAN HAHN LPC PLLC DBA CREATING CHANGE COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2020
-----------------------------------------------------
Last Update Date | 03/11/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1308 OAK ST UNIT A
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-5339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-764-7964
-----------------------------------------------------
Fax | 501-932-6379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1308 OAK ST UNIT A
-----------------------------------------------------
City | CONWAY
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72034-5339
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-764-7964
-----------------------------------------------------
Fax | 501-932-6379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ALAN HAHN
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 501-764-7964
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------