Provider Demographics
NPI:1295367076
Name:HANSEN, GEORGIA (LCPC)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:HANSEN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:SHULTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 CENTRAL AVE STE 503
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-3128
Mailing Address - Country:US
Mailing Address - Phone:406-534-9520
Mailing Address - Fax:406-278-1229
Practice Address - Street 1:410 CENTRAL AVE STE 503
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3128
Practice Address - Country:US
Practice Address - Phone:406-750-1801
Practice Address - Fax:406-278-1229
Is Sole Proprietor?:No
Enumeration Date:2020-02-10
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-48284101YM0800X, 2084P0800X
MTBBH-PCLC-LIC-42651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health