Provider Demographics
NPI:1407417082
Name:HANNAH WILSON LCPC, LLC
Entity Type:Organization
Organization Name:HANNAH WILSON LCPC, LLC
Other - Org Name:PRICKLY PEACH SEX THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:RACHAEL
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:406-595-5855
Mailing Address - Street 1:PO BOX 512
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-0512
Mailing Address - Country:US
Mailing Address - Phone:406-461-1650
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5810
Practice Address - Country:US
Practice Address - Phone:406-595-5855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-25
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty