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NPI Code Detail

MEDICARE: MS. JENNIE LEE HANSON MA, MFT INTERN

MEDICARE: MS. JENNIE LEE HANSON MA, MFT INTERN
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
1106H00000XMarriage & Family TherapistIMF 41268CA

General Provider Information

NPI Number : 1306997663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIE LEE HANSON MA, MFT INTERN
Provider Business Mailing Address
First Line : 18719 PALM ST
Second Line :
City : FOUNTAIN VALLEY
State : CA
Zip : 92708-6440
Country : US
Telephone Number : 714-968-4361
Fax Number :
Provider Business Practice Location Address
First Line : 3100 S HARBOR BLVD
Second Line : SUITE 200
City : SANTA ANA
State : CA
Zip : 92704-6823
Country : US
Telephone Number : 714-966-8656
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2007
Last Update Date : 07/08/2007

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