Provider Demographics
NPI:1861831042
Name:HANSEN, LISA T (ASSO MFT)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:T
Last Name:HANSEN
Suffix:
Gender:F
Credentials:ASSO MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 S 1130 W
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-9603
Mailing Address - Country:US
Mailing Address - Phone:801-465-2784
Mailing Address - Fax:
Practice Address - Street 1:1031 S 1130 W
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-9603
Practice Address - Country:US
Practice Address - Phone:801-465-2784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4859896-3904106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist