Healthcare Provider Details

I. General information

NPI: 1083905194
Provider Name (Legal Business Name): BEVERLY HANSON M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date: 10/18/2017
Reactivation Date: 10/24/2017

III. Provider practice location address

1420 WILLOW PASS RD STE 200
CONCORD CA
94520-5823
US

IV. Provider business mailing address

1420 WILLOW PASS RD STE 200
CONCORD CA
94520-5823
US

V. Phone/Fax

Practice location:
  • Phone: 925-321-4294
  • Fax:
Mailing address:
  • Phone: 925-321-4294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106338
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: