Provider Demographics
NPI:1114330396
Name:HANSEN, LISA ANN (MSAC, CATC-IV)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSAC, CATC-IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 W MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-4438
Mailing Address - Country:US
Mailing Address - Phone:209-725-1060
Mailing Address - Fax:
Practice Address - Street 1:1343 W MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-4438
Practice Address - Country:US
Practice Address - Phone:209-725-1060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)