Provider Demographics
NPI:1649653502
Name:HANSEN, TONYA (LPC)
Entity type:Individual
Prefix:
First Name:TONYA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TONYA
Other - Middle Name:
Other - Last Name:DALLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:354 BURNS RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-5614
Mailing Address - Country:US
Mailing Address - Phone:724-712-9590
Mailing Address - Fax:
Practice Address - Street 1:229 S MARKET ST
Practice Address - Street 2:
Practice Address - City:NEW WILMINGTON
Practice Address - State:PA
Practice Address - Zip Code:16142-1242
Practice Address - Country:US
Practice Address - Phone:724-712-9590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC010561101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health