Provider Demographics
NPI:1194067249
Name:HANSEN, CARI JOY
Entity type:Individual
Prefix:
First Name:CARI
Middle Name:JOY
Last Name:HANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 152
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65704-0152
Mailing Address - Country:US
Mailing Address - Phone:417-924-2326
Mailing Address - Fax:417-924-2327
Practice Address - Street 1:103 N BUSINESS 60
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MO
Practice Address - Zip Code:65704
Practice Address - Country:US
Practice Address - Phone:417-924-2326
Practice Address - Fax:417-924-2327
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-26
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014028627106H00000X
MO2015043407101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1194067249Medicaid