Healthcare Provider Details

I. General information

NPI: 1689236515
Provider Name (Legal Business Name): KIEL HANSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 MCPHERSON AVE # GL300
COUNCIL BLUFFS IA
51503-5175
US

IV. Provider business mailing address

2211 HOWARD ST APT 201
OMAHA NE
68102-2445
US

V. Phone/Fax

Practice location:
  • Phone: 308-940-1527
  • Fax: 712-796-2312
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number096584
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: