Provider Demographics
NPI:1770675803
Name:HANSON, SHELLEY A (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:HANSON
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 1:15709 W MCKINLEY ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3237
Mailing Address - Country:US
Mailing Address - Phone:503-620-3302
Mailing Address - Fax:
Practice Address - Street 1:15709 W MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3237
Practice Address - Country:US
Practice Address - Phone:503-620-3302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0544106H00000X
101YM0800X
ORC1888101YP2500X
AZ15642106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional