Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY-005220 | AZ |
Y | 103TC0700X | Clinical Psychologist | PSY-005220 | AZ |
NPI | 1003424383 |
---|---|
Provider Name | Dr. Ciara Hansen |
First Address | Farmington, NM 87402-4457 |
Second Address | Shiprock, NM 87420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2020 |
Last Update Date | 22/07/2020 |