Provider Demographics
NPI:1205045861
Name:HANSEN, SANDRA M (MFT)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 PORTAGE BAY E
Mailing Address - Street 2:SUITE 10
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-3073
Mailing Address - Country:US
Mailing Address - Phone:530-758-1282
Mailing Address - Fax:
Practice Address - Street 1:2655 PORTAGE BAY E
Practice Address - Street 2:SUITE 10
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-3073
Practice Address - Country:US
Practice Address - Phone:530-758-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist