Provider Demographics
NPI:1447686969
Name:HANNIG, PAUL J (PHD, MFT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:HANNIG
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10170 LARWIN AVE UNIT 4
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-7489
Mailing Address - Country:US
Mailing Address - Phone:818-882-7404
Mailing Address - Fax:
Practice Address - Street 1:10170 LARWIN AVE UNIT 4
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-7489
Practice Address - Country:US
Practice Address - Phone:818-882-7404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT26018106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist