Provider Demographics
NPI:1982638326
Name:HANSEN, MARY L (LMHC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 CENTRAL AVE
Mailing Address - Street 2:APT 706
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1481
Mailing Address - Country:US
Mailing Address - Phone:509-663-6408
Mailing Address - Fax:
Practice Address - Street 1:701 N MILLER ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2086
Practice Address - Country:US
Practice Address - Phone:509-662-7195
Practice Address - Fax:509-662-4588
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00006487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health