Provider Demographics
NPI:1215566161
Name:HAMILTON, JACQUELINE (LPC)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 SW 26TH AVE STE 4000
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-3175
Mailing Address - Country:US
Mailing Address - Phone:812-896-4733
Mailing Address - Fax:
Practice Address - Street 1:3014 SW 26TH AVE STE 4000
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-3175
Practice Address - Country:US
Practice Address - Phone:812-896-4733
Practice Address - Fax:806-310-2660
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79317101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional