Provider Demographics
NPI:1629060777
Name:HANSEN, BETH JEANNINE (LMHP, CCGC)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:JEANNINE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMHP, CCGC
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:JEANNINE
Other - Last Name:CROSTON HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHP, CCGC
Mailing Address - Street 1:4920 S 30TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68107-1590
Mailing Address - Country:US
Mailing Address - Phone:402-502-8961
Mailing Address - Fax:402-991-5642
Practice Address - Street 1:4920 S 30TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68107-1590
Practice Address - Country:US
Practice Address - Phone:402-502-8961
Practice Address - Fax:402-991-5642
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3342101YM0800X
NE38101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor