Provider Demographics
NPI:1316110307
Name:HANLEY, KERRY D (LCPC)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:D
Last Name:HANLEY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:THOMPSON FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59873-2142
Mailing Address - Country:US
Mailing Address - Phone:406-827-3594
Mailing Address - Fax:
Practice Address - Street 1:307 3RD AVE WEST
Practice Address - Street 2:
Practice Address - City:THOMPSON FALLS
Practice Address - State:MT
Practice Address - Zip Code:59873-0129
Practice Address - Country:US
Practice Address - Phone:406-496-6314
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1348101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0255892Medicaid