Active NPI
Colton Bragg Hackley, LCPC
- Counselor
- Kalispell, MT
National Provider Identifier
1619986056
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1265
- Practice address
- 20 3Rd St E
Kalispell, MT 59901-4573 - Phone
- (406) 755-9471
- Fax
- (406) 758-8113
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1265 | MT | Primary |
Addresses
Primary practice location
20 3Rd St E
Kalispell, MT 59901-4573
Mailing address
1930 Teal Dr
Kalispell, MT 59901-7583
Phone (406) 755-1079
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0255374 | Medicaid | MT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1265 | MT | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1619986056",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1930 TEAL DR",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599017583",
"telephone_number": "406-755-1079"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "20 3RD ST E",
"city": "KALISPELL",
"state": "MT",
"postal_code": "599014573",
"telephone_number": "406-755-9471",
"fax_number": "406-758-8113"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HACKLEY",
"first_name": "COLTON",
"middle_name": "BRAGG",
"credential": "LCPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "MT",
"license": "1265",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0255374",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kalispell, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.