| Doctor Name: | SHELLY HANSEN |
| NPI Number: | 1730341603 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | LMSW 26043 |
| Business Practice Address: | 740 Mckinley Ave Kellogg, ID - 838372693 |
| Business Phone Number: | 2087830600 |
| Business Fax Number: | 2087830192 |
| Mailing Address: | 202 E Anton Ave, Ste 206 COEUR D ALENE |
| State: | ID |
| Postal Code: | 838153727 |
| Phone Number: | 2086676095 |
| Fax Number: | 2086676173 |
| NPI Enumeration Date: | 07/01/2008 |
| NPI Last Update Date: | 07/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | LMSW 26043 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ID |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |