MEDICARE: MR. ERIC MARTYN HANSEN LPC: 0019254

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC.0019254	CO
2	101YM0800X	Mental Health Counselor	24355	AZ

General Provider Information

NPI Number	:	1215623525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MARTYN HANSEN LPC: 0019254

Provider Business Mailing Address
First Line	:	1196 N GRANT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-2377
Country	:	US
Telephone Number	:	720-261-3990
Fax Number	:

Provider Business Practice Location Address
First Line	:	6232 N 7TH ST STE 101
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-1850
Country	:	US
Telephone Number	:	602-694-6313
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2023
Last Update Date	:	12/11/2025

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