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NPI Code Detail

MEDICARE: VICTOR D HANSON LAC, BSW

MEDICARE: VICTOR D HANSON LAC, BSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor1262MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11262OTHERMTSTATE LICENSE

General Provider Information

NPI Number : 1295055028
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTOR D HANSON LAC, BSW
Provider Business Mailing Address
First Line : PO BOX 7115
Second Line :
City : KALISPELL
State : MT
Zip : 59904-0115
Country : US
Telephone Number : 406-756-6453
Fax Number :
Provider Business Practice Location Address
First Line : 1312 N MERIDIAN RD
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3095
Country : US
Telephone Number : 406-756-6453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2010
Last Update Date : 06/03/2010

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