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Individual

THEO C HANSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LCSW

Contact information

Practice address
600 CENTRAL AVE STE 408, GREAT FALLS, MT 59401-3141
(406) 205-3433
Mailing address
600 CENTRAL AVE STE 408, GREAT FALLS, MT 59401-3141
(406) 205-3433

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7313085
MT
Enumeration date
11/01/2021
Last updated
11/04/2021
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