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General NPI Number Information
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NPI Number | 1821487547
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Entity Type | Individual
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Provider Name | ALISSA HANSEN LCSW
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Gender | Female
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Dates
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Enumeration Date | 01/19/2015
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Last Update Date | 11/10/2021
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Provider Practice Location Address
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Address Line | 51728 INDIANA STATE ROUTE 933
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City | SOUTH BEND
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State | IN
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Zip | 46637-1706
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Country | US
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Telephone | 574-298-0962
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Fax |
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Provider Business Mailing Address
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Address Line | 150 SYLVAN GLEN DR
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City | SOUTH BEND
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State | IN
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Zip | 46615-3115
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Country | US
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Telephone | 574-334-1118
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 34008218A
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License Number State | IN
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