Provider Demographics
NPI:1538601133
Name:HANSON, AVA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:AVA
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:MARIE
Other - Last Name:CRUMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 W 1750 S APT 1
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4101
Mailing Address - Country:US
Mailing Address - Phone:435-494-1214
Mailing Address - Fax:
Practice Address - Street 1:2535 S HIGHWAY 89 STE 4
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-6728
Practice Address - Country:US
Practice Address - Phone:435-494-1214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9066126-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist