Provider Demographics
NPI:1356398309
Name:HANSON, TERRY A (MED, LCPC)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:HANSON
Suffix:
Gender:F
Credentials:MED, LCPC
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 201
Mailing Address - Street 2:
Mailing Address - City:GILDFORD
Mailing Address - State:MT
Mailing Address - Zip Code:59525-0201
Mailing Address - Country:US
Mailing Address - Phone:406-376-3279
Mailing Address - Fax:
Practice Address - Street 1:521 4TH ST
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501
Practice Address - Country:US
Practice Address - Phone:406-395-4305
Practice Address - Fax:406-395-5997
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT744101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT742820OtherBC/BS PROVIDER #
MT0256945Medicaid