Provider Demographics
NPI:1881191500
Name:WILSON, HANNAH RACHAEL (MA, LCPC)
Entity type:Individual
Prefix:MISS
First Name:HANNAH
Middle Name:RACHAEL
Last Name:WILSON
Suffix:
Gender:F
Credentials:MA, 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 512
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59771-0512
Mailing Address - Country:US
Mailing Address - Phone:406-595-5855
Mailing Address - Fax:
Practice Address - Street 1:2050 FAIRWAY DR STE 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-5810
Practice Address - Country:US
Practice Address - Phone:406-595-5855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-09
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-30190101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional