Provider Demographics
NPI:1760198568
Name:HANSEL, MICHELE MARIE (ADC-T)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARIE
Last Name:HANSEL
Suffix:
Gender:F
Credentials:ADC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:MICHELE HANSEL
Mailing Address - Street 2:24604 UNIVERSITY AVE NW
Mailing Address - City:ISANTI
Mailing Address - State:MN
Mailing Address - Zip Code:55040
Mailing Address - Country:US
Mailing Address - Phone:763-218-6819
Mailing Address - Fax:
Practice Address - Street 1:5842 OLD MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6698
Practice Address - Country:US
Practice Address - Phone:651-401-3078
Practice Address - Fax:651-674-2534
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2853101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)