Provider Demographics
NPI:1194859090
Name:HAMM, ARCHY D
Entity Type:Individual
Prefix:MR
First Name:ARCHY
Middle Name:D
Last Name:HAMM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S OCOTILLO DR
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2329
Mailing Address - Country:US
Mailing Address - Phone:928-684-6714
Mailing Address - Fax:
Practice Address - Street 1:920 S. VULTURE MINE ROAD
Practice Address - Street 2:SPECIAL SERVICE OFFICE
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390
Practice Address - Country:US
Practice Address - Phone:928-684-6714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ103141OtherAHCCCS PROVIDER NUMBER