Healthcare Provider Details

I. General information

NPI: 1215623525
Provider Name (Legal Business Name): ERIC MARTYN HANSEN LPC: 0019254
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6232 N 7TH ST STE 101
PHOENIX AZ
85014-1850
US

IV. Provider business mailing address

1196 N GRANT ST
DENVER CO
80203-2377
US

V. Phone/Fax

Practice location:
  • Phone: 602-694-6313
  • Fax:
Mailing address:
  • Phone: 720-261-3990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number24355
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC.0019254
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: