Provider Demographics
NPI:1154996536
Name:HANLEY, JACI MARIE (LAC,SWLC)
Entity type:Individual
Prefix:
First Name:JACI
Middle Name:MARIE
Last Name:HANLEY
Suffix:
Gender:F
Credentials:LAC,SWLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 CENTENNIAL AVE
Mailing Address - Street 2:
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-2870
Mailing Address - Country:US
Mailing Address - Phone:406-496-6000
Mailing Address - Fax:406-496-6035
Practice Address - Street 1:445 CENTENNIAL AVE
Practice Address - Street 2:
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-2870
Practice Address - Country:US
Practice Address - Phone:406-723-4075
Practice Address - Fax:406-723-3059
Is Sole Proprietor?:No
Enumeration Date:2021-05-26
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
MTBBH-LCSW-LIC-720751041C0700X
MTBBH-LAC-LIC-57045101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical