Provider Demographics
NPI:1184868192
Name:HANSEN, ABBIGAIL EDITH (MHR)
Entity Type:Individual
Prefix:
First Name:ABBIGAIL
Middle Name:EDITH
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 N GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:SAND SPRINGS
Mailing Address - State:OK
Mailing Address - Zip Code:74063-6719
Mailing Address - Country:US
Mailing Address - Phone:918-402-3192
Mailing Address - Fax:
Practice Address - Street 1:212 N GRANT AVE
Practice Address - Street 2:
Practice Address - City:SAND SPRINGS
Practice Address - State:OK
Practice Address - Zip Code:74063-6719
Practice Address - Country:US
Practice Address - Phone:918-402-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health