Provider Demographics
NPI:1770257560
Name:HANSEN, SHANNON J (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:HANSEN
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1500 QUESADA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2772
Mailing Address - Country:US
Mailing Address - Phone:510-600-8519
Mailing Address - Fax:
Practice Address - Street 1:4456 BLACK AVE STE 200
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-6116
Practice Address - Country:US
Practice Address - Phone:510-600-8519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124045106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist