Provider Demographics
NPI:1225180607
Name:HANSEN, RUSS SCOTT
Entity Type:Individual
Prefix:
First Name:RUSS
Middle Name:SCOTT
Last Name:HANSEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2169 FLORAL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-7307
Mailing Address - Country:US
Mailing Address - Phone:530-342-6993
Mailing Address - Fax:530-877-1978
Practice Address - Street 1:766 EAST AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1252
Practice Address - Country:US
Practice Address - Phone:530-891-8876
Practice Address - Fax:530-877-1978
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35998106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherBLUE CROSS