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General NPI Number Information
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NPI Number | 1093805095
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Entity Type | Organization
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Legal Business Name | HANSEN THERAPY, LLC
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 2717 N GRANDVIEW BLVD SUITE 110
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 414-303-4205
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Fax |
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Provider Business Mailing Address
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Address Line | 2717 N GRANDVIEW BLVD SUITE 110
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City | WAUKESHA
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State | WI
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Zip | 53188-1672
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Country | US
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Telephone | 414-303-4205
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Fax |
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Authorized Official
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Title or Position | LICENSED PSYCHOLOGIST/OWNER
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Name | DR. PETER JOHN HANSEN
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Credential | PHD
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Telephone | 414-303-4205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 2072-057
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License Number State | WI
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