Provider Demographics
NPI:1326242454
Name:HAMILTON, MARILYN (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 KINGSBURY ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-3624
Mailing Address - Country:US
Mailing Address - Phone:713-747-6416
Mailing Address - Fax:713-747-6416
Practice Address - Street 1:4450 S WAYSIDE DR
Practice Address - Street 2:SUITE 100B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-1126
Practice Address - Country:US
Practice Address - Phone:713-645-1400
Practice Address - Fax:713-747-6416
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4972103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)