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General NPI Number Information
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NPI Number | 1831525492
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Entity Type | Individual
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Provider Name | CONNIE J HANNON LMHC
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Gender | Female
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Dates
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Enumeration Date | 09/16/2013
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 410 E JEFFERSON ST
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City | STARKE
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State | FL
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Zip | 32091-3333
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Country | US
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Telephone | 283-524-8996
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Fax |
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Provider Business Mailing Address
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Address Line | 135 N CHURCH ST
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City | STARKE
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State | FL
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Zip | 32091-3411
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Country | US
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Telephone | 352-575-3413
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH11301
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License Number State | FL
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