MEDICARE: SHELLEY ANN HANSEN LMFT

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	106H00000X	Marriage & Family Therapist	218492	AK

General Provider Information

NPI Number	:	1518765395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLEY ANN HANSEN LMFT

Provider Business Mailing Address
First Line	:	1359 NORMANDY CT
Second Line	:
City	:	FORT WAINWRIGHT
State	:	AK
Zip	:	99703-1371
Country	:	US
Telephone Number	:	703-589-4630
Fax Number	:

Provider Business Practice Location Address
First Line	:	1359 NORMANDY CT
Second Line	:
City	:	FORT WAINWRIGHT
State	:	AK
Zip	:	99703-1371
Country	:	US
Telephone Number	:	703-589-4630
Fax Number	:

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

Provider Enumeration Date	:	03/06/2025
Last Update Date	:	03/06/2025

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