Provider Demographics
NPI:1538998307
Name:HANSEN, CHARLES FLOYD (QMHA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:FLOYD
Last Name:HANSEN
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:CHARLIE
Other - Middle Name:
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6238 CASCADE HWY NE
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-9701
Mailing Address - Country:US
Mailing Address - Phone:971-382-8176
Mailing Address - Fax:
Practice Address - Street 1:7759 SE 72ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-7921
Practice Address - Country:US
Practice Address - Phone:503-788-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-30
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health