Provider Demographics
NPI:1093994741
Name:HANSEN, WILLIAM A (MFT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 S INDUSTRY WAY
Mailing Address - Street 2:SUITE 45
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7899
Mailing Address - Country:US
Mailing Address - Phone:208-922-2207
Mailing Address - Fax:208-922-4168
Practice Address - Street 1:690 S INDUSTRY WAY
Practice Address - Street 2:SUITE 45
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7899
Practice Address - Country:US
Practice Address - Phone:208-922-2207
Practice Address - Fax:208-922-4168
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCOUI3582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health