Provider Demographics
NPI:1578988911
Name:HANSEN, DEBRA
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:763 S 1280 W
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84015-8515
Mailing Address - Country:US
Mailing Address - Phone:801-708-9023
Mailing Address - Fax:801-779-7808
Practice Address - Street 1:2317 N HILL FIELD RD
Practice Address - Street 2:STE 103
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-4781
Practice Address - Country:US
Practice Address - Phone:801-708-9023
Practice Address - Fax:801-779-7808
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-21
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT345045-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional