Basic Information
| Provider Information | |||||||||
| NPI: | 1417994690 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSEN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | H. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PSYD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5001 HIGHWAY190 | ||||||||
| Address2: | SUITE B1 | ||||||||
| City: | COVINGTON | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9855905744 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3860 W OGDEN AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606232460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738433000 | ||||||||
| FaxNumber: | 7738432704 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 05/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TP0016X | MP.0017 | LA | Y | Behavioral Health & Social Service Providers | Psychologist | Prescribing (Medical) |
No ID Information.