Provider Demographics
NPI:1003102237
Name:LARRY E HAMME PH.D
Entity Type:Organization
Organization Name:LARRY E HAMME PH.D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HANUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-936-7575
Mailing Address - Street 1:4125 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-2063
Mailing Address - Country:US
Mailing Address - Phone:419-472-7330
Mailing Address - Fax:419-472-8675
Practice Address - Street 1:4125 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2063
Practice Address - Country:US
Practice Address - Phone:419-472-7330
Practice Address - Fax:419-472-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH62003909103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0804795Medicaid
OH0804795Medicaid