MEDICARE: CHRISOTPHER LLOYD 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
1	103T00000X	Psychologist	1497	AL

General Provider Information

NPI Number	:	1699765495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISOTPHER LLOYD HANSEN PH.D.

Provider Business Mailing Address
First Line	:	10709 BOSWELL LANE
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-6307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	40022 SUPPORT AVE
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-4752
Country	:	US
Telephone Number	:	254-287-7281
Fax Number	:

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

Provider Enumeration Date	:	10/24/2005
Last Update Date	:	10/15/2011

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