Healthcare Provider Details

I. General information

NPI: 1104436559
Provider Name (Legal Business Name): ANDREA D HANSON LCMHC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 07/31/2020
Certification Date: 07/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W 2750 S
BOUNTIFUL UT
84010-6418
US

IV. Provider business mailing address

11 W 2750 S
BOUNTIFUL UT
84010-6418
US

V. Phone/Fax

Practice location:
  • Phone: 801-928-4833
  • Fax:
Mailing address:
  • Phone: 801-928-4833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREA D HANSON
Title or Position: OWNER AND THERAPIST
Credential: LCMHC
Phone: 385-355-4505