Provider Demographics
NPI:1306432786
Name:HACKMAN, STEPHANIE (LCPC)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:HACKMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2765 WYLIE DR TRLR 80
Mailing Address - Street 2:
Mailing Address - City:EAST HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59635-3057
Mailing Address - Country:US
Mailing Address - Phone:406-410-1860
Mailing Address - Fax:
Practice Address - Street 1:2765 WYLIE DR TRLR 80
Practice Address - Street 2:
Practice Address - City:EAST HELENA
Practice Address - State:MT
Practice Address - Zip Code:59635-3057
Practice Address - Country:US
Practice Address - Phone:406-924-9211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-18
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCPC-LIC-46702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional