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NPI Code Detail

MEDICARE: MR. AUSTIN LEE HANNAH LPC-IT

MEDICARE: MR. AUSTIN LEE HANNAH LPC-IT
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
1101YM0800XMental Health Counselor7465-226WI

General Provider Information

NPI Number : 1992489322
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. AUSTIN LEE HANNAH LPC-IT
Provider Business Mailing Address
First Line : W2193 WILMERS GROVE RD
Second Line :
City : EAST TROY
State : WI
Zip : 53120-2074
Country : US
Telephone Number : 262-379-4449
Fax Number :
Provider Business Practice Location Address
First Line : 2600 N MAYFAIR RD STE 400
Second Line :
City : WAUWATOSA
State : WI
Zip : 53226-1306
Country : US
Telephone Number : 414-939-9390
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/14/2023
Last Update Date : 06/14/2023

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