Provider Demographics
NPI:1891930228
Name:HANSON, SHIRLEY D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:D
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHIRLEY
Other - Middle Name:D
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3003 N CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2902
Mailing Address - Country:US
Mailing Address - Phone:602-685-6000
Mailing Address - Fax:602-685-6001
Practice Address - Street 1:1415 N 1ST ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-685-6001
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMSW-12619104100000X
AZLCSW-165811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ341664Medicaid