Provider Demographics
NPI:1578588539
Name:HANSON, SHIRLEY MAY (PMHNP, PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:MAY
Last Name:HANSON
Suffix:
Gender:F
Credentials:PMHNP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 SW CARMEL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6951
Mailing Address - Country:US
Mailing Address - Phone:503-245-8099
Mailing Address - Fax:503-452-8571
Practice Address - Street 1:7912 SW 35TH AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2427
Practice Address - Country:US
Practice Address - Phone:503-452-8571
Practice Address - Fax:503-452-8571
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR084051100N6 PMHNP-PP103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent