Healthcare Provider Details

I. General information

NPI: 1821269002
Provider Name (Legal Business Name): ERIC HANSON PHD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 03/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 E MURRAY HOLLADAY ROAD #222
SALT LAKE CITY UT
84117
US

IV. Provider business mailing address

2040 E MURRAY HOLLADAY ROAD #222
SALT LAKE CITY UT
84117
US

V. Phone/Fax

Practice location:
  • Phone: 801-278-0499
  • Fax: 801-278-0489
Mailing address:
  • Phone: 801-278-0499
  • Fax: 801-278-0489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number901159852501
License Number StateUT

VIII. Authorized Official

Name: MR. ERIC HANSON
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 801-278-0499