Provider Demographics
NPI:1386961522
Name:HANSON, MICHAEL S (CADC II MS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:HANSON
Suffix:
Gender:M
Credentials:CADC II MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 SW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97333
Mailing Address - Country:US
Mailing Address - Phone:541-738-6832
Mailing Address - Fax:541-738-6410
Practice Address - Street 1:518 SW 3RD ST.
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97333
Practice Address - Country:US
Practice Address - Phone:541-738-6832
Practice Address - Fax:541-738-6410
Is Sole Proprietor?:No
Enumeration Date:2010-04-28
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)