Individual
TYLER HANSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, CCS
Contact information
Practice address
343 FOREST AVE, PORTLAND, ME 04101-2006
(207) 772-9800
Mailing address
1184 HIGHLAND AVE, SOUTH PORTLAND, ME 04106-7807
(207) 318-8629
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LC8120
ME
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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