Provider Demographics
NPI:1366809790
Name:HANSEN BEHAVIORAL HEALTH A PSYCHOLOGICAL CORPORATION
Entity type:Organization
Organization Name:HANSEN BEHAVIORAL HEALTH A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:SUSANA
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:213-448-2835
Mailing Address - Street 1:524 N MARYLAND AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-2266
Mailing Address - Country:US
Mailing Address - Phone:213-448-2835
Mailing Address - Fax:213-405-2413
Practice Address - Street 1:524 N MARYLAND AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-2266
Practice Address - Country:US
Practice Address - Phone:213-448-2835
Practice Address - Fax:213-405-2413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27482103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty