Provider Demographics
NPI:1659363414
Name:HANSEN, LAURA E (LPC)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:E
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12032
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79768-2032
Mailing Address - Country:US
Mailing Address - Phone:432-288-8357
Mailing Address - Fax:
Practice Address - Street 1:600 TX- 349
Practice Address - Street 2:
Practice Address - City:IRAAN
Practice Address - State:TX
Practice Address - Zip Code:79744
Practice Address - Country:US
Practice Address - Phone:432-639-2575
Practice Address - Fax:432-639-6292
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13625101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3901LPCOtherBC/BS
TX028104001Medicaid