Healthcare Provider Details

I. General information

NPI: 1265745855
Provider Name (Legal Business Name): KRISTINA HANSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2010
Last Update Date: 07/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E REDLANDS BLVD STE 234
REDLANDS CA
92373-4724
US

IV. Provider business mailing address

1540 BARTON RD # 176
REDLANDS CA
92373-5439
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax: 909-335-3167
Mailing address:
  • Phone: 909-336-6846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number39692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: