Healthcare Provider Details

I. General information

NPI: 1730666090
Provider Name (Legal Business Name): JESSICA MARIE HANSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 AMERICAS WAY # 25884
BOX ELDER SD
57719-7600
US

IV. Provider business mailing address

514 AMERICAS WAY # 25884
BOX ELDER SD
57719-7600
US

V. Phone/Fax

Practice location:
  • Phone: 310-405-5804
  • Fax:
Mailing address:
  • Phone: 310-405-5804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT.0001857
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT4129
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT11649
License Number StateSD
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberCTB-2026-0373
License Number StateNM
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT-667
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number203494
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT107626
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: