1124232087 NPI number — MS. JAMIE LEE HANNA MA MFT ATRBC

Table of content: MS. JAMIE LEE HANNA MA MFT ATRBC (NPI 1124232087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124232087 NPI number — MS. JAMIE LEE HANNA MA MFT ATRBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANNA
Provider First Name:
JAMIE
Provider Middle Name:
LEE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA MFT ATRBC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HALLER
Provider Other First Name:
JAMIE
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124232087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 S AMPHLETT BLVD
Provider Second Line Business Mailing Address:
# 118
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-655-2724
Provider Business Mailing Address Fax Number:
650-655-2729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 S AMPHLETT BLVD
Provider Second Line Business Practice Location Address:
# 118
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-655-2724
Provider Business Practice Location Address Fax Number:
650-655-2729
Provider Enumeration Date:
05/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC28215 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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