Individual
CHARLIE N HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
265 E CHUBBUCK RD, CHUBBUCK, ID 83202-5055
(208) 237-1711
(208) 237-9806
Mailing address
1027 N UNIVERSITY AVE, BLACKFOOT, ID 83221-1862
(208) 716-3003
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LPC-7001
ID
Other
Enumeration date
04/08/2021
Last updated
04/08/2021
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