Individual
MR. GARY D HANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT
Contact information
Practice address
7200 HEMLOCK LN N SUITE 108, MAPLE GROVE, MN 55369-5576
(763) 533-5339
(763) 390-0862
Mailing address
7200 HEMLOCK LN N SUITE 108, MAPLE GROVE, MN 55369-5576
(763) 533-5339
(763) 390-0863
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
1241
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107643
HEALTH PART ID NUMBER
MN
01
—
1241
LMFT LICENSE NUMBER
MN
01
—
337M8HA
BCBS MN PROVIDER ID
MN
01
—
62-90571
MEDICA ID NUMBER
MN
05
—
697608500
—
MN
Enumeration date
10/24/2005
Last updated
10/27/2014
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