Provider Demographics
NPI:1669507836
Name:HANSEN, CAROL M (MFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:390 S SEPULVEDA BLVD
Mailing Address - Street 2:307
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-3100
Mailing Address - Country:US
Mailing Address - Phone:310-476-4685
Mailing Address - Fax:310-476-4685
Practice Address - Street 1:11911 SAN VICENTE BLVD
Practice Address - Street 2:280
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-5086
Practice Address - Country:US
Practice Address - Phone:310-280-8400
Practice Address - Fax:310-476-4685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT34133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health