Provider Demographics
NPI:1871210591
Name:STANDAGE, HANNAH (LAC)
Entity type:Individual
Prefix:
First Name:HANNAH
Middle Name:
Last Name:STANDAGE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:1185 CRIMSON CLOVER DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-7558
Mailing Address - Country:US
Mailing Address - Phone:501-472-1857
Mailing Address - Fax:
Practice Address - Street 1:523 LOCUST AVE
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-5324
Practice Address - Country:US
Practice Address - Phone:150-147-2185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA2210005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health