1629060777 NPI number — BETH JEANNINE HANSEN LMHP, CCGC

Table of content: BETH JEANNINE HANSEN LMHP, CCGC (NPI 1629060777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629060777 NPI number — BETH JEANNINE HANSEN LMHP, CCGC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANSEN
Provider First Name:
BETH
Provider Middle Name:
JEANNINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMHP, CCGC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CROSTON HANSEN
Provider Other First Name:
BETH
Provider Other Middle Name:
JEANNINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMHP, CCGC
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1629060777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4920 S 30TH ST
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68107-1590
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-502-8961
Provider Business Mailing Address Fax Number:
402-991-5642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4920 S 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68107-1590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-502-8961
Provider Business Practice Location Address Fax Number:
402-991-5642
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  3342 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101Y00000X , with the licence number: 38 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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