Provider Demographics
NPI:1053050039
Name:MAHANNA, BRITTANIE
Entity type:Individual
Prefix:
First Name:BRITTANIE
Middle Name:
Last Name:MAHANNA
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 1:2205 CROSSFIELD DR UNIT B
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7847
Mailing Address - Country:US
Mailing Address - Phone:270-272-4000
Mailing Address - Fax:
Practice Address - Street 1:2205 CROSSFIELD DR UNIT B
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7847
Practice Address - Country:US
Practice Address - Phone:270-272-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health