Healthcare Provider Details

I. General information

NPI: 1316631757
Provider Name (Legal Business Name): KEVIN CONRAD HANAUER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2023
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 MERCURY VILLAGE DR
DURANGO CO
81301-8955
US

IV. Provider business mailing address

PO BOX 1328
DURANGO CO
81302-1328
US

V. Phone/Fax

Practice location:
  • Phone: 970-335-2342
  • Fax: 970-335-2438
Mailing address:
  • Phone: 970-335-2342
  • Fax: 970-335-2438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: