Provider Demographics
NPI:1326383001
Name:SPANG, ALAN (CADC II)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:SPANG
Suffix:
Gender:M
Credentials:CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX67
Mailing Address - Street 2:101 EAGLEFEATHER DR
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-6381
Mailing Address - Fax:406-477-6425
Practice Address - Street 1:101 EAGLEFEATHER DR
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043-0067
Practice Address - Country:US
Practice Address - Phone:406-477-6381
Practice Address - Fax:406-477-6425
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ508101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)