Provider Demographics
NPI:1578919619
Name:HANSON, CODY MATTHEW (MS, LPC)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:MATTHEW
Last Name:HANSON
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3380 ERIE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-1626
Mailing Address - Country:US
Mailing Address - Phone:513-399-6511
Mailing Address - Fax:
Practice Address - Street 1:3380 ERIE AVE STE 202
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-1626
Practice Address - Country:US
Practice Address - Phone:513-759-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-08
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional