Healthcare Provider Details

I. General information

NPI: 1902231772
Provider Name (Legal Business Name): ERIC R HANSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2013
Last Update Date: 02/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E INDIAN SCHOOL RD PHOENIX VA HEALTHCARE SYSTEM; DEPARTMENT OF PSYCH(116B)
PHOENIX AZ
85012-1845
US

IV. Provider business mailing address

605 E INDIAN SCHOOL RD PHOENIX VA HEALTHCARE SYSTEM; DEPARTMENT OF PSYCH(116B)
PHOENIX AZ
85012-1845
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-277-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY26679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: