Provider Demographics
NPI:1386289023
Name:HAWLEY, TESCHA ANN (LCSW)
Entity type:Individual
Prefix:
First Name:TESCHA
Middle Name:ANN
Last Name:HAWLEY
Suffix:
Gender:F
Credentials:LCSW
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 1152
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:MT
Mailing Address - Zip Code:59526-1152
Mailing Address - Country:US
Mailing Address - Phone:406-399-1577
Mailing Address - Fax:
Practice Address - Street 1:18243 STATE HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:HARLEM
Practice Address - State:MT
Practice Address - Zip Code:59526-9099
Practice Address - Country:US
Practice Address - Phone:406-399-1577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-SWLC-LIC-390721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTBBH-SWLC-LIC-39072Medicaid