Provider Demographics
NPI:1457897498
Name:HANSEN, TASHA L (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:TASHA
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MSW, LICSW
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 133
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-1910
Mailing Address - Country:US
Mailing Address - Phone:509-656-4517
Mailing Address - Fax:
Practice Address - Street 1:100 E JACKSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3692
Practice Address - Country:US
Practice Address - Phone:509-933-8777
Practice Address - Fax:509-933-8741
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACO61459897101YA0400X
WALH60738072101YM0800X
WALW60835798104100000X, 1041C0700X, 171M00000X
WALW6088357981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2089116Medicaid
WA8953970OtherLABOR AND INDUSTRIES
WA2203415Medicaid