Provider Demographics
NPI:1558961904
Name:HANSEN, TERESA LYNN (MA, LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:LYNN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:LYNN
Other - Last Name:MAYFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1839 N WOLFE PENN ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5058
Mailing Address - Country:US
Mailing Address - Phone:509-843-7208
Mailing Address - Fax:
Practice Address - Street 1:211 E COEUR D ALENE AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4926
Practice Address - Country:US
Practice Address - Phone:208-699-6817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional