Provider Demographics
NPI:1366595787
Name:HANSEN, RAYMOND JAMES (LPC)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JAMES
Last Name:HANSEN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-0815
Mailing Address - Country:US
Mailing Address - Phone:814-849-0019
Mailing Address - Fax:814-849-0033
Practice Address - Street 1:173 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825-0815
Practice Address - Country:US
Practice Address - Phone:814-849-0019
Practice Address - Fax:814-849-0033
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC001152101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional