Provider Demographics
NPI:1871082305
Name:HANSON, MICAH FRANKLIN (MS, BCBA CERTIFICATE)
Entity type:Individual
Prefix:MR
First Name:MICAH
Middle Name:FRANKLIN
Last Name:HANSON
Suffix:
Gender:M
Credentials:MS, BCBA CERTIFICATE
Other - Prefix:MR
Other - First Name:MICAH
Other - Middle Name:FRANKLIN
Other - Last Name:HANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:2560 METRO BLVD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-2417
Mailing Address - Country:US
Mailing Address - Phone:314-715-3855
Mailing Address - Fax:
Practice Address - Street 1:2560 METRO BLVD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-2417
Practice Address - Country:US
Practice Address - Phone:314-715-3855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014026407103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst