Provider Demographics
NPI:1982308862
Name:HANSON, CHERYL D (LMFT 138777)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMFT 138777
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3685 CAMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:IONE
Mailing Address - State:CA
Mailing Address - Zip Code:95640-9690
Mailing Address - Country:US
Mailing Address - Phone:209-274-2514
Mailing Address - Fax:
Practice Address - Street 1:3685 CAMANCHE RD
Practice Address - Street 2:
Practice Address - City:IONE
Practice Address - State:CA
Practice Address - Zip Code:95640-9690
Practice Address - Country:US
Practice Address - Phone:209-304-8894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist