Healthcare Provider Details

I. General information

NPI: 1053370999
Provider Name (Legal Business Name): WILLIAM ALBERT HANSHAW LCSW,ACSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 06/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 N LINCOLN ST
BLOOMINGTON IN
47408-3447
US

IV. Provider business mailing address

711 N LINCOLN ST
BLOOMINGTON IN
47408-3447
US

V. Phone/Fax

Practice location:
  • Phone: 812-333-2263
  • Fax:
Mailing address:
  • Phone: 812-333-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3400193A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34001493A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number34001493A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number34001493A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: