Provider Demographics
NPI:1366676447
Name:HANSEN, PAMELA ELAINE (LPC)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ELAINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 KITTY HAWK ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:UNIVERSAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78148-3829
Mailing Address - Country:US
Mailing Address - Phone:409-692-6068
Mailing Address - Fax:210-598-1910
Practice Address - Street 1:5890 FM 1515 N
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3521
Practice Address - Country:US
Practice Address - Phone:409-692-6068
Practice Address - Fax:210-598-1910
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional