Healthcare Provider Details

I. General information

NPI: 1114836046
Provider Name (Legal Business Name): LISA HANSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 N RIVER ST STE 1A
HAILEY ID
83333-8438
US

IV. Provider business mailing address

PO BOX 5895
HAILEY ID
83333-5895
US

V. Phone/Fax

Practice location:
  • Phone: 406-546-2025
  • Fax:
Mailing address:
  • Phone: 406-546-2025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLMSW-7971979
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: