Provider Demographics
NPI:1093885642
Name:HAMSTRA, CHRISTINE J (LCSW LMFT MAC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:J
Last Name:HAMSTRA
Suffix:
Gender:F
Credentials:LCSW LMFT MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 GOLDHAWK LANE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022
Mailing Address - Country:US
Mailing Address - Phone:817-285-0333
Mailing Address - Fax:817-285-0334
Practice Address - Street 1:500 GOLDHAWK LANE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022
Practice Address - Country:US
Practice Address - Phone:817-285-0333
Practice Address - Fax:817-285-0334
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5166381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
00S059Medicare ID - Type Unspecified