Individual
LILLIAN HANSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1384 BIRCH ST., 1384 BIRCH ST., MONTARA, CA 94037
(650) 455-3743
Mailing address
PO BOX 371323, MONTARA, CA 94037-1323
(650) 455-3743
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
—
—
106H00000X
Marriage & Family Therapist
—
—
221700000X
Art Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93594302G17093
MEDICAL
CA
Enumeration date
06/08/2018
Last updated
06/08/2018
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