Healthcare Provider Details

I. General information

NPI: 1598678377
Provider Name (Legal Business Name): RILEY MICHAEL HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4923 LINCOLN WAY
AMES IA
50014-3616
US

IV. Provider business mailing address

1417 MAYFIELD DR UNIT 308
AMES IA
50014-5571
US

V. Phone/Fax

Practice location:
  • Phone: 800-531-4236
  • Fax: 319-483-6661
Mailing address:
  • Phone: 712-260-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number139978
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: