MEDICARE: MR. SHAWN D HANSEN MFT

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	01006	NV

General Provider Information

NPI Number	:	1639249543
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN D HANSEN MFT

Provider Business Mailing Address
First Line	:	2159 PATRIOTIC LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-4832
Country	:	US
Telephone Number	:	702-638-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	4538 W CRAIG RD
Second Line	:	290
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032-2508
Country	:	US
Telephone Number	:	702-486-5518
Fax Number	:	702-486-5630

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/08/2007

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