Basic Information
| Provider Information | |||||||||
| NPI: | 1336296771 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HANAUER | ||||||||
| FirstName: | ALLISON | ||||||||
| MiddleName: | CLIFFORD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PH.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JEFFREY | ||||||||
| OtherFirstName: | ALLISON | ||||||||
| OtherMiddleName: | CLIFFORD | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1211 UNION AVE STE 330 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381046655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014780954 | ||||||||
| FaxNumber: | 9014780951 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 NEW COVINGTON PIKE STE 110 | ||||||||
| Address2: | |||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381282595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9013872900 | ||||||||
| FaxNumber: | 9013841645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 10/06/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 1180 | AL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 2676 | TN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.