Provider Demographics
NPI:1811205438
Name:HANSEN, PAUL MATTHEW (LPCC #1845)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:MATTHEW
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LPCC #1845
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3270 KERNER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-4840
Mailing Address - Country:US
Mailing Address - Phone:415-473-2879
Mailing Address - Fax:415-473-6313
Practice Address - Street 1:3270 KERNER BLVD STE A
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-4840
Practice Address - Country:US
Practice Address - Phone:415-473-2879
Practice Address - Fax:415-473-6313
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1845101YP2500X, 101YM0800X
MT15041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical