MEDICARE: ANNE ELISABETH HANSON LPCC

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	101YM0800X	Mental Health Counselor	CC01112	MN
2	101YM0800X	Mental Health Counselor	180010690	IL
3	101YM0800X	Mental Health Counselor	9217	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q957194253121	OTHER	MN	DRIVERS LICENSE

General Provider Information

NPI Number	:	1265009161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE ELISABETH HANSON LPCC

Provider Business Mailing Address
First Line	:	1751 N KENMORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4011
Country	:	US
Telephone Number	:	312-231-9196
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 N KENMORE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-4011
Country	:	US
Telephone Number	:	312-231-9196
Fax Number	:

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

Provider Enumeration Date	:	06/08/2021
Last Update Date	:	06/28/2021

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Directions to “ ANNE ELISABETH HANSON LPCC” Practice Location

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