Provider Demographics
NPI:1760739486
Name:HENSLEY, STEVEN DEAN (LMT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:DEAN
Last Name:HENSLEY
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 W KENT AVE
Mailing Address - Street 2:SUIT F
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-6636
Mailing Address - Country:US
Mailing Address - Phone:406-240-0692
Mailing Address - Fax:
Practice Address - Street 1:1119 W KENT AVE
Practice Address - Street 2:SUIT F
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6636
Practice Address - Country:US
Practice Address - Phone:406-240-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist