Provider Demographics
NPI:1396030466
Name:DAVID W HAMILTON PSYD PLLC
Entity Type:Organization
Organization Name:DAVID W HAMILTON PSYD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:616-930-4123
Mailing Address - Street 1:4829 E BELTLINE AVE NE
Mailing Address - Street 2:BLDG 1, SUITE 100
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-9747
Mailing Address - Country:US
Mailing Address - Phone:616-364-3301
Mailing Address - Fax:866-379-2151
Practice Address - Street 1:550 CASCADE WEST PKWY SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2137
Practice Address - Country:US
Practice Address - Phone:616-930-4123
Practice Address - Fax:616-323-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013050103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty