Provider Demographics
NPI:1790411866
Name:FAST HORSE, ALAN DEAN (BBHPSS)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:DEAN
Last Name:FAST HORSE
Suffix:
Gender:M
Credentials:BBHPSS
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 1027
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-1027
Mailing Address - Country:US
Mailing Address - Phone:406-768-3852
Mailing Address - Fax:406-768-5202
Practice Address - Street 1:603 1/2 COURT AVE.
Practice Address - Street 2:
Practice Address - City:POPLAR
Practice Address - State:MT
Practice Address - Zip Code:59255
Practice Address - Country:US
Practice Address - Phone:406-768-3852
Practice Address - Fax:406-768-5202
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-BHPS-CRT-50151175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist