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NPI Code Detail

MEDICARE: MRS. CAITLYN HANNUM MA, LLPC

MEDICARE: MRS. CAITLYN HANNUM MA, LLPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorMI
2101YM0800XMental Health CounselorMI

General Provider Information

NPI Number : 1467115444
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CAITLYN HANNUM MA, LLPC
Provider Business Mailing Address
First Line : 3424 CHICAGO DR
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-1408
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3424 CHICAGO DR
Second Line :
City : HUDSONVILLE
State : MI
Zip : 49426-1408
Country : US
Telephone Number : 616-426-9034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2021
Last Update Date : 10/18/2021

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