Healthcare Provider Details

I. General information

NPI: 1861416760
Provider Name (Legal Business Name): MARY CREER HANSEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S WADSWORTH BLVD 4-170
LAKEWOOD CO
80226-4300
US

IV. Provider business mailing address

803 S PEARL ST
DENVER CO
80209-4221
US

V. Phone/Fax

Practice location:
  • Phone: 303-980-8111
  • Fax: 303-722-0209
Mailing address:
  • Phone: 303-980-8111
  • Fax: 303-722-0209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number471
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: