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General NPI Number Information
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NPI Number | 1972131290
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Entity Type | Individual
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Provider Name | TIMOTHY HANSON
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Gender | Male
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 1394 JACKSON ST STE 300
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City | SAINT PAUL
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State | MN
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Zip | 55117-4669
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Country | US
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Telephone | 651-478-7815
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Fax |
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Provider Business Mailing Address
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Address Line | 7235 GUIDER DR APT 105
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City | WOODBURY
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State | MN
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Zip | 55125-5344
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Country | US
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Telephone | 651-361-0025
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 304742
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License Number State | MN
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