Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | G60655200 | WA |
N | 106E00000X | Assistant Behavior Analyst | AB60925122 | WA |
NPI | 1114375045 |
---|---|
Provider Name | Mollie Hansen |
First Address | Yakima, WA 98908-3479 |
Second Address | Yakima, WA 98908 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 24/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2061184 | (05) | WA |