MEDICARE: MELANIE E HANSEN LPC

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	101Y00000X	Counselor	20288	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84971L	OTHER	TX	BCBS
2	84973L	OTHER	TX	BCBS
3	84970L	OTHER	TX	BCBS
4	84968L	OTHER	TX	BCBS
5	84969L	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1790835064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELANIE E HANSEN LPC

Provider Business Mailing Address
First Line	:	PO BOX 226656
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75222-6656
Country	:	US
Telephone Number	:	214-943-9431
Fax Number	:	214-943-9407

Provider Business Practice Location Address
First Line	:	1002 MONTGOMERY ST STE 200
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76107-2693
Country	:	US
Telephone Number	:	214-943-9431
Fax Number	:	214-943-9407

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	07/08/2007

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Directions to “ MELANIE E HANSEN LPC” Practice Location

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