Provider Demographics
NPI:1518765395
Name:HANSEN, SHELLEY ANN (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANN
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 NORMANDY CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-1371
Mailing Address - Country:US
Mailing Address - Phone:703-589-4630
Mailing Address - Fax:
Practice Address - Street 1:1359 NORMANDY CT
Practice Address - Street 2:
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-1371
Practice Address - Country:US
Practice Address - Phone:703-589-4630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK218492106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist