Provider Demographics
NPI:1457897498
Name:HANSEN, TASHA L (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:TASHA
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 465
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1915
Mailing Address - Country:US
Mailing Address - Phone:509-899-7685
Mailing Address - Fax:855-644-1338
Practice Address - Street 1:200 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3347
Practice Address - Country:US
Practice Address - Phone:509-925-9821
Practice Address - Fax:509-925-9073
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW608357981041C0700X, 171M00000X
WA6088357981041C0700X, 104100000X
WA60738072101YM0800X
WACO61459897101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2203415Medicaid
WA8953970OtherLABOR AND INDUSTRIES
WA2089116Medicaid