Healthcare Provider Details

I. General information

NPI: 1225180607
Provider Name (Legal Business Name): RUSS SCOTT HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 EAST AVE
CHICO CA
95926-1252
US

IV. Provider business mailing address

2169 FLORAL AVE
CHICO CA
95926-7307
US

V. Phone/Fax

Practice location:
  • Phone: 530-891-8876
  • Fax: 530-877-1978
Mailing address:
  • Phone: 530-342-6993
  • Fax: 530-877-1978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC35998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: