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NPI Code Detail

MEDICARE: DR. BRIAN HANSEN PH.D.

MEDICARE: DR. BRIAN HANSEN PH.D.
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
1103TC0700XClinical Psychologist8918949-2501UT

General Provider Information

NPI Number : 1497068910
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN HANSEN PH.D.
Provider Business Mailing Address
First Line : 993 EAST 300 SOUTH
Second Line :
City : PROVO
State : UT
Zip : 84606-5156
Country : US
Telephone Number : 801-310-2133
Fax Number :
Provider Business Practice Location Address
First Line : 125 EAST 300 SOUTH SUITE 207
Second Line :
City : PROVO
State : UT
Zip : 84606-5156
Country : US
Telephone Number : 801-477-6940
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2010
Last Update Date : 09/02/2016

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