Provider Demographics
NPI:1609362888
Name:HANSEN HEARTS COUNSELING, PLLC
Entity Type:Organization
Organization Name:HANSEN HEARTS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC
Authorized Official - Phone:701-361-8870
Mailing Address - Street 1:3519 PIERCE ST S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7506
Mailing Address - Country:US
Mailing Address - Phone:701-361-8870
Mailing Address - Fax:701-403-8003
Practice Address - Street 1:3309 FIECHTNER DR S STE H
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-2375
Practice Address - Country:US
Practice Address - Phone:701-239-2567
Practice Address - Fax:701-403-8003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND84261515261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1470012Medicaid