Provider Demographics
NPI:1760419972
Name:HANSEN, PAMELA G (LPC/LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:G
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC/LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7331
Mailing Address - Country:US
Mailing Address - Phone:318-325-4881
Mailing Address - Fax:318-324-8806
Practice Address - Street 1:101 WOOD ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7331
Practice Address - Country:US
Practice Address - Phone:318-325-4881
Practice Address - Fax:318-324-8806
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1832101YP2500X
LA20106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist