Provider Demographics
NPI:1285611350
Name:HANSON, DAVID EVANS (PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EVANS
Last Name:HANSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 NORTH AVE
Mailing Address - Street 2:STE 201
Mailing Address - City:LA FOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766-2732
Mailing Address - Country:US
Mailing Address - Phone:423-566-1314
Mailing Address - Fax:423-566-2466
Practice Address - Street 1:219 NORTH AVE
Practice Address - Street 2:STE 201
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-2732
Practice Address - Country:US
Practice Address - Phone:423-566-1314
Practice Address - Fax:423-566-2466
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC845101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
251165000OtherMAGELLAN
4057512OtherBLUE CROSS BLUE SHIELD
251165000OtherAETNA