Healthcare Provider Details

I. General information

NPI: 1841555331
Provider Name (Legal Business Name): LUKE KENNETH HANSEN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 07/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 E PLUMB LN 100
RENO NV
89502-3540
US

IV. Provider business mailing address

575 E PLUMB LN 100
RENO NV
89502-3540
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-0623
  • Fax: 775-337-2971
Mailing address:
  • Phone: 775-329-0623
  • Fax: 775-337-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6251-C
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: