Basic Information
| Provider Information | |||||||||
| NPI: | 1245947282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | HAYDEN | ||||||||
| MiddleName: | ARTIS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 637 ASHLEY RD | ||||||||
| Address2: | |||||||||
| City: | WEST CHAZY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129922607 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184207360 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2155 NY-22B | ||||||||
| Address2: | |||||||||
| City: | MORRISONVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 12962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185638000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.