Provider Demographics
NPI:1891459269
Name:HANSEN, COLLINS MOUNGER (LPC)
Entity Type:Individual
Prefix:
First Name:COLLINS
Middle Name:MOUNGER
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:COLLINS
Other - Middle Name:HARTFIELD
Other - Last Name:MOUNGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4154 RUSSELL BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-3612
Mailing Address - Country:US
Mailing Address - Phone:314-833-3863
Mailing Address - Fax:
Practice Address - Street 1:1300 HAMPTON AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3138
Practice Address - Country:US
Practice Address - Phone:314-833-3863
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020036830101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor