Provider Demographics
NPI:1376178855
Name:HAMILTON, COURTNEY JADE (CLEC, IBCLC)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:JADE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CLEC, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 TOWNLAKE DR
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-8983
Mailing Address - Country:US
Mailing Address - Phone:214-546-5256
Mailing Address - Fax:
Practice Address - Street 1:107 MURRAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1645
Practice Address - Country:US
Practice Address - Phone:469-608-0071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2020-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN