Provider Demographics
NPI:1972701167
Name:HANSON, COLLEEN ANN (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:SALINE
Mailing Address - State:MI
Mailing Address - Zip Code:48176-9573
Mailing Address - Country:US
Mailing Address - Phone:517-375-2380
Mailing Address - Fax:
Practice Address - Street 1:285 TAMARACK DR
Practice Address - Street 2:
Practice Address - City:SALINE
Practice Address - State:MI
Practice Address - Zip Code:48176-9573
Practice Address - Country:US
Practice Address - Phone:517-375-2380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401008666101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional