Provider Demographics
NPI:1033458559
Name:HAMILTON, HEATHER ANN (LMLP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:ANN
Other - Last Name:WOOLDRIDGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMLP
Mailing Address - Street 1:635 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3602
Mailing Address - Country:US
Mailing Address - Phone:316-660-7600
Mailing Address - Fax:316-660-7510
Practice Address - Street 1:1919 N AMIDON AVE
Practice Address - Street 2:STE 130
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-2117
Practice Address - Country:US
Practice Address - Phone:316-660-7675
Practice Address - Fax:316-832-1571
Is Sole Proprietor?:No
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2419103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling