Provider Demographics
NPI:1881732436
Name:HANSEN, DALE F (DMIN, PHD)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:F
Last Name:HANSEN
Suffix:
Gender:M
Credentials:DMIN, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 W STELLA LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2046
Mailing Address - Country:US
Mailing Address - Phone:602-870-9619
Mailing Address - Fax:602-242-9178
Practice Address - Street 1:8433 N BLACK CANYON HWY
Practice Address - Street 2:SUITE 100-4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4873
Practice Address - Country:US
Practice Address - Phone:602-870-9619
Practice Address - Fax:602-242-9178
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT #0060101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional