Individual
DR. MARK P HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1360 ENERGY PARK DR, SUITE 340, SAINT PAUL, MN 55108-5276
(651) 646-8985
(651) 646-3959
Mailing address
1360 ENERGY PARK DR, SUITE 340, SAINT PAUL, MN 55108-5276
(651) 646-8985
(651) 646-3959
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP 1440
MN
103TC1900X
Counseling Psychologist
LP 1440
MN
103TP2701X
Group Psychotherapy Psychologist
LP 1440
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01009904
PREFERRED ONE
MN
01
—
42GI3HA
BLUE CROSS& BLUE SHEILD
MN
05
—
643353700
—
MN
Enumeration date
12/07/2005
Last updated
09/24/2008
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