Provider Demographics
NPI:1023274289
Name:VASQUEZ-HANSEN, MARY (LCPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:VASQUEZ-HANSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 W COLLEGE DR
Mailing Address - Street 2:1ST FLOOR (BEYONG HEALING)
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-1001
Mailing Address - Country:US
Mailing Address - Phone:708-310-5034
Mailing Address - Fax:708-448-7266
Practice Address - Street 1:7600 W COLLEGE DR
Practice Address - Street 2:1ST FLOOR (BEYONG HEALING)
Practice Address - City:PALOS HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60463-1001
Practice Address - Country:US
Practice Address - Phone:708-310-5034
Practice Address - Fax:708-448-7266
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.007529101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional