Provider Demographics
NPI:1023066164
Name:HANSHAW, DOUGLAS ERIC (MS, CAC III)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ERIC
Last Name:HANSHAW
Suffix:
Gender:M
Credentials:MS, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 CR 14A
Mailing Address - Street 2:PO BOX 1407
Mailing Address - City:OURAY
Mailing Address - State:CO
Mailing Address - Zip Code:81427-1407
Mailing Address - Country:US
Mailing Address - Phone:970-596-1412
Mailing Address - Fax:970-325-0200
Practice Address - Street 1:100 W. COLORADO AVE.
Practice Address - Street 2:SUITE 225
Practice Address - City:TELLURIDE
Practice Address - State:CO
Practice Address - Zip Code:81435
Practice Address - Country:US
Practice Address - Phone:970-596-1412
Practice Address - Fax:970-325-0200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6365101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)