Healthcare Provider Details

I. General information

NPI: 1316110307
Provider Name (Legal Business Name): KERRY D HANLEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 3RD AVE WEST
THOMPSON FALLS MT
59873-0129
US

IV. Provider business mailing address

PO BOX 2142
THOMPSON FALLS MT
59873-2142
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-6314
  • Fax: 406-494-1724
Mailing address:
  • Phone: 406-827-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1348
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: