Provider Demographics
NPI:1316782451
Name:HANNER, MARY SAGE
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:SAGE
Last Name:HANNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201212
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-8212
Mailing Address - Country:US
Mailing Address - Phone:210-338-0127
Mailing Address - Fax:
Practice Address - Street 1:2245 CHURCH RD
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-0702
Practice Address - Country:US
Practice Address - Phone:806-290-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional