MEDICARE: DOUGLAS ERIC HANSHAW MS, CAC III

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	6365	CO

General Provider Information

NPI Number	:	1023066164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ERIC HANSHAW MS, CAC III

Provider Business Mailing Address
First Line	:	751 CR 14A
Second Line	:	PO BOX 1407
City	:	OURAY
State	:	CO
Zip	:	81427-1407
Country	:	US
Telephone Number	:	970-596-1412
Fax Number	:	970-325-0200

Provider Business Practice Location Address
First Line	:	100 W. COLORADO AVE.
Second Line	:	SUITE 225
City	:	TELLURIDE
State	:	CO
Zip	:	81435
Country	:	US
Telephone Number	:	970-596-1412
Fax Number	:	970-325-0200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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