Provider Demographics
NPI:1336694405
Name:LEAH HANSON, PMHNP, BC, PLLC
Entity Type:Organization
Organization Name:LEAH HANSON, PMHNP, BC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:701-500-7599
Mailing Address - Street 1:24 MAIN ST N
Mailing Address - Street 2:SUITE I
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3104
Mailing Address - Country:US
Mailing Address - Phone:701-500-7599
Mailing Address - Fax:701-516-8026
Practice Address - Street 1:24 MAIN ST N
Practice Address - Street 2:SUITE I
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-3104
Practice Address - Country:US
Practice Address - Phone:701-500-7599
Practice Address - Fax:701-516-8026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29510261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)