Doctor Name: | K. GENE HANSEN |
NPI Number: | 1760469555 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 831120242501 |
Business Practice Address: | 3809 W 6200 S Kearns, UT - 841183725 |
Business Phone Number: | 8019634209 |
Business Fax Number: | 8019634299 |
Mailing Address: | 1976 Wasatch Dr, SALT LAKE CITY |
State: | UT |
Postal Code: | 841083326 |
Phone Number: | 8014743292 |
Fax Number: | |
NPI Enumeration Date: | 12/22/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 831120242501 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |