Provider Demographics
NPI:1356143929
Name:HARTFORD, WILLLIAM RUSSELL (CBHPSS)
Entity type:Individual
Prefix:
First Name:WILLLIAM
Middle Name:RUSSELL
Last Name:HARTFORD
Suffix:
Gender:
Credentials:CBHPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:133 CARDIFF AVE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2751
Mailing Address - Country:US
Mailing Address - Phone:406-253-0218
Mailing Address - Fax:
Practice Address - Street 1:390 HODGSON RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA FALLS
Practice Address - State:MT
Practice Address - Zip Code:59912-9063
Practice Address - Country:US
Practice Address - Phone:406-897-2788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-BHPS-CRT-42888175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist