Healthcare Provider Details

I. General information

NPI: 1356143929
Provider Name (Legal Business Name): WILLLIAM RUSSELL HARTFORD CBHPSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 HODGSON RD
COLUMBIA FALLS MT
59912-9063
US

IV. Provider business mailing address

133 CARDIFF AVE
KALISPELL MT
59901-2751
US

V. Phone/Fax

Practice location:
  • Phone: 406-897-2788
  • Fax:
Mailing address:
  • Phone: 406-253-0218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberBBH-BHPS-CRT-42888
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: