Provider Demographics
NPI:1407022528
Name:HAMILTON, ERVIN EUGENE (LLP)
Entity Type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:EUGENE
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49081 YE OLDE WOODS
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9702
Mailing Address - Country:US
Mailing Address - Phone:269-668-7236
Mailing Address - Fax:
Practice Address - Street 1:49081 YE OLDE WOODS
Practice Address - Street 2:
Practice Address - City:MATTAWAN
Practice Address - State:MI
Practice Address - Zip Code:49071-9702
Practice Address - Country:US
Practice Address - Phone:269-668-7236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist