MEDICARE: MR. CODY MATTHEW HANSON MS, LPC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1578919619
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CODY MATTHEW HANSON MS, LPC

Provider Business Mailing Address
First Line	:	3380 ERIE AVE STE 202
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-399-6511
Fax Number	:

Provider Business Practice Location Address
First Line	:	3380 ERIE AVE STE 202
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45208-1626
Country	:	US
Telephone Number	:	513-759-9744
Fax Number	:

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

Provider Enumeration Date	:	05/08/2016
Last Update Date	:	10/07/2020

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