MEDICARE: MR. FRED J HANSEN I M.A.

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	101YP2500X	Professional Counselor	16694	TX

General Provider Information

NPI Number	:	1750341707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRED J HANSEN I M.A.

Provider Business Mailing Address
First Line	:	3253 INDEPENDENCE PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-1972
Country	:	US
Telephone Number	:	972-985-7565
Fax Number	:	888-664-0571

Provider Business Practice Location Address
First Line	:	3253 INDEPENDENCE PKWY
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75075-1972
Country	:	US
Telephone Number	:	972-985-7565
Fax Number	:	888-664-0571

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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