Provider Demographics
NPI:1659825271
Name:HANSON, CONNIE (LCMHC)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3771 E CRIMSON FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780-1897
Mailing Address - Country:US
Mailing Address - Phone:208-221-2583
Mailing Address - Fax:435-359-5183
Practice Address - Street 1:230 N 1680 E STE T2
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2573
Practice Address - Country:US
Practice Address - Phone:435-767-1064
Practice Address - Fax:435-359-5183
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10376305-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health