Healthcare Provider Details

I. General information

NPI: 1790616985
Provider Name (Legal Business Name): DR. BRIAN HANSEN PHD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

993 E 300 S
PROVO UT
84606-5156
US

IV. Provider business mailing address

993 E 300 S
PROVO UT
84606-5156
US

V. Phone/Fax

Practice location:
  • Phone: 801-477-6940
  • Fax:
Mailing address:
  • Phone: 801-477-6940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: AUBREY MANHART
Title or Position: BILLING MANAGER
Credential:
Phone: 801-602-1705