Provider Demographics
NPI:1669849527
Name:HANSON, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HANSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 TENNESSEE ST
Mailing Address - Street 2:SUITE Y
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-8163
Mailing Address - Country:US
Mailing Address - Phone:909-798-9547
Mailing Address - Fax:
Practice Address - Street 1:414 TENNESSEE ST
Practice Address - Street 2:SUITE Y
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8163
Practice Address - Country:US
Practice Address - Phone:909-798-9547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor