Provider Demographics
NPI:1891083531
Name:HANSEN, JULIE A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:A
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 2ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-4675
Mailing Address - Country:US
Mailing Address - Phone:530-902-3246
Mailing Address - Fax:
Practice Address - Street 1:424 2ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-4675
Practice Address - Country:US
Practice Address - Phone:530-902-3246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23554103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical