Provider Demographics
NPI:1558018119
Name:GOGGINS, HANNAH MARIE
Entity type:Individual
Prefix:MS
First Name:HANNAH
Middle Name:MARIE
Last Name:GOGGINS
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 1:1443 CIMARRON TRL
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-3921
Mailing Address - Country:US
Mailing Address - Phone:832-720-2541
Mailing Address - Fax:
Practice Address - Street 1:161 SUMMIT AVE STE 200
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7072
Practice Address - Country:US
Practice Address - Phone:214-494-9779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
TX99090101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty