Provider Demographics
NPI:1750341707
Name:HANSEN, FRED J I (MA)
Entity type:Individual
Prefix:MR
First Name:FRED
Middle Name:J
Last Name:HANSEN
Suffix:I
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 INDEPENDENCE PKWY
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-1972
Mailing Address - Country:US
Mailing Address - Phone:972-985-7565
Mailing Address - Fax:888-664-0571
Practice Address - Street 1:3253 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-1972
Practice Address - Country:US
Practice Address - Phone:972-985-7565
Practice Address - Fax:888-664-0571
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16694101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional