Individual
MR. WALLACE D HARTMAN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S. LCPC
Contact information
Practice address
307 1ST AVE E, SUITE 20A, KALISPELL, MT 59901-4978
(406) 257-5838
Mailing address
PO BOX 10714, KALISPELL, MT 59904-3714
(406) 257-5838
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC 1073
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0256633
—
MT
01
—
74252-0
BLUE CROSS OF MONTANA
MT
Enumeration date
06/26/2006
Last updated
07/08/2007
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