Provider Demographics
NPI:1447583059
Name:HANSON, LACEY (MS, LPC)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:
Last Name:HANSON
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1221
Mailing Address - Street 2:
Mailing Address - City:ENNIS
Mailing Address - State:MT
Mailing Address - Zip Code:59729
Mailing Address - Country:US
Mailing Address - Phone:406-451-1439
Mailing Address - Fax:
Practice Address - Street 1:6 WAPITI LANE
Practice Address - Street 2:
Practice Address - City:ENNIS
Practice Address - State:MT
Practice Address - Zip Code:59729
Practice Address - Country:US
Practice Address - Phone:406-451-1439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-14
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1183101YM0800X
MT4593101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health