Provider Demographics
NPI:1598102071
Name:HANSON, MICHAEL J
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:J
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-2221
Mailing Address - Country:US
Mailing Address - Phone:626-263-9133
Mailing Address - Fax:626-359-4285
Practice Address - Street 1:2502 E HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-2221
Practice Address - Country:US
Practice Address - Phone:626-263-9133
Practice Address - Fax:626-359-4285
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist