Provider Demographics
NPI:1801930672
Name:HANSEN, JAMES GORDON (LCSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:GORDON
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LCSW
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 992993
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-2993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 SATURN SKWY
Practice Address - Street 2:30
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2813
Practice Address - Country:US
Practice Address - Phone:530-224-4822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS219531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical