Provider Demographics
NPI:1922048099
Name:HANSEN, JAMES T (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:HANSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 MCGILL DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48309-2310
Mailing Address - Country:US
Mailing Address - Phone:248-375-2201
Mailing Address - Fax:
Practice Address - Street 1:13087 E 11 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48088-4782
Practice Address - Country:US
Practice Address - Phone:586-754-3060
Practice Address - Fax:586-754-4010
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401006264103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN47450001Medicare ID - Type Unspecified