Tyler Hanson, LADC, CCS

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

LC8120 Issued in ME

Practice address

343 Forest Ave
Portland, ME 04101-2006

Phone

(207) 772-9800

NPI assigned

Nov 7, 2022

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Liberty Bay Recovery Center, LLC

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Portland, ME
  • NPI 1104212182
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667779200000",
    "number": "1952019101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1184 HIGHLAND AVE",
            "city": "SOUTH PORTLAND",
            "state": "ME",
            "postal_code": "041067807",
            "telephone_number": "207-318-8629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "343 FOREST AVE",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041012006",
            "telephone_number": "207-772-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSON",
        "first_name": "TYLER",
        "credential": "LADC, CCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-07",
        "last_updated": "2022-11-07",
        "certification_date": "2022-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "LC8120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janet Hanseth, L.M.T.
• Ashland Morgan Hanson, MS, BCBA
• Camille Lillian Hanson, PA-C
• Jamie Hanson
• Monica J Hanson, CCC, SLP
• Happy Home Care LLC
• Happy Minds ABA Corp
• Hara Holistic Body Center
• Vaughn A Hardesty, PH.D.
• Molly Ann Hardman, LCSW

• Addiction (Substance Use Disorder) Counselor in Portland, ME
• Providers in Portland, ME by specialty
• Addiction (Substance Use Disorder) Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.