MEDICARE: GWENDOLINE HANSEN MA MPT LIC MFT27233

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFT27233	CA

General Provider Information

NPI Number	:	1356518583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLINE HANSEN MA MPT LIC MFT27233

Provider Business Mailing Address
First Line	:	4741 LAUREL CYN BLVD
Second Line	:	SUITE 105
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-763-9977
Fax Number	:

Provider Business Practice Location Address
First Line	:	4741 LAUREL CYN BLVD
Second Line	:	#105
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607
Country	:	US
Telephone Number	:	818-763-9977
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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