Provider Demographics
NPI:1902099260
Name:HANSEN, TRAYCE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRAYCE
Middle Name:L
Last Name:HANSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:277 RANCHEROS DR
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2976
Practice Address - Country:US
Practice Address - Phone:760-471-4073
Practice Address - Fax:619-528-4625
Is Sole Proprietor?:No
Enumeration Date:2007-08-21
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 16380103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
260649881OtherEIN
CAW416Medicare PIN
260649881OtherEIN
CACP16380AMedicare UPIN