Provider Demographics
NPI:1124658513
Name:HANSON, DESIREE LAUREN (LCPC)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LAUREN
Last Name:HANSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:DESIREE
Other - Middle Name:LAUREN
Other - Last Name:DAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:136 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1165
Mailing Address - Country:US
Mailing Address - Phone:586-565-0568
Mailing Address - Fax:
Practice Address - Street 1:907 E 75TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1658
Practice Address - Country:US
Practice Address - Phone:586-565-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS03737101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional