Healthcare Provider Details

I. General information

NPI: 1710440979
Provider Name (Legal Business Name): BROOKE HANSEN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 02/15/2023
Certification Date: 02/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 S 360 E
AMERICAN FORK UT
84003-2590
US

IV. Provider business mailing address

654 S AUSTRIAN PINE DR
LAYTON UT
84041-7540
US

V. Phone/Fax

Practice location:
  • Phone: 435-494-1256
  • Fax:
Mailing address:
  • Phone: 435-494-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number11755257-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: