Provider Demographics
NPI:1669660742
Name:HANSEN, EVANGELINE F (LPC)
Entity Type:Individual
Prefix:MS
First Name:EVANGELINE
Middle Name:F
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 1:1000 N 9TH ST STE 6
Mailing Address - Street 2:P.O. BOX 4424
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-3107
Mailing Address - Country:US
Mailing Address - Phone:970-257-1805
Mailing Address - Fax:
Practice Address - Street 1:1000 N 9TH ST STE 6
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-3107
Practice Address - Country:US
Practice Address - Phone:970-257-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-14
Last Update Date:2007-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4372101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health