MEDICARE: DR. DALE F HANSEN D.MIN., 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	101YP2500X	Professional Counselor	LMFT #0060	AZ

General Provider Information

NPI Number	:	1881732436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE F HANSEN D.MIN., PH.D.

Provider Business Mailing Address
First Line	:	1804 W STELLA LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85015-2046
Country	:	US
Telephone Number	:	602-870-9619
Fax Number	:	602-242-9178

Provider Business Practice Location Address
First Line	:	8433 N BLACK CANYON HWY
Second Line	:	SUITE 100-4
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4873
Country	:	US
Telephone Number	:	602-870-9619
Fax Number	:	602-242-9178

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

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	02/14/2014

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