MEDICARE: MS. LAURA E. HANSEN L.P.C.

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	101Y00000X	Counselor	13625	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3901LPC	OTHER	TX	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659363414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAURA E. HANSEN L.P.C.

Provider Business Mailing Address
First Line	:	PO BOX 12032
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79768-2032
Country	:	US
Telephone Number	:	432-288-8357
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 TX- 349
Second Line	:
City	:	IRAAN
State	:	TX
Zip	:	79744
Country	:	US
Telephone Number	:	432-639-2575
Fax Number	:	432-639-6292

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

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	02/25/2016

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