Healthcare Provider Details

I. General information

NPI: 1770675803
Provider Name (Legal Business Name): SHELLEY A HANSON LPC, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 01/31/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15709 W MCKINLEY ST
GOODYEAR AZ
85338-3237
US

IV. Provider business mailing address

15709 W MCKINLEY ST
GOODYEAR AZ
85338-3237
US

V. Phone/Fax

Practice location:
  • Phone: 503-620-3302
  • Fax:
Mailing address:
  • Phone: 503-620-3302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC1888
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT0544
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number15642
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: