Provider Demographics
NPI:1215623525
Name:HANSEN, ERIC MARTYN (LPC: 0019254)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MARTYN
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LPC: 0019254
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1196 N GRANT ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-2377
Mailing Address - Country:US
Mailing Address - Phone:720-261-3990
Mailing Address - Fax:
Practice Address - Street 1:1200 28TH ST STE 205
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1756
Practice Address - Country:US
Practice Address - Phone:303-993-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-11
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0019254101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional