Provider Demographics
NPI:1881236180
Name:HANSEN, SHEILA LYNN
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30251 GOLDEN LANTERN STE E-500
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-5993
Mailing Address - Country:US
Mailing Address - Phone:949-424-4083
Mailing Address - Fax:
Practice Address - Street 1:1601 DOVE ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2410
Practice Address - Country:US
Practice Address - Phone:949-424-4083
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115782106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist