Provider Demographics
NPI:1528448255
Name:HANSEN, HAYLEY ROSE (MC, LPC)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:ROSE
Last Name:HANSEN
Suffix:
Gender:F
Credentials:MC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 S LAZONA DR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85204-5101
Mailing Address - Country:US
Mailing Address - Phone:480-717-2223
Mailing Address - Fax:
Practice Address - Street 1:1063 S LAZONA DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-5101
Practice Address - Country:US
Practice Address - Phone:480-717-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-14590101YP2500X
AZLPC-16371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional