Provider Demographics
NPI: | 1437664604 |
---|---|
Name: | HAMERLY, MICHAEL (LPC, CAC II) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | |
Last Name: | HAMERLY |
Suffix: | |
Gender: | M |
Credentials: | LPC, CAC II |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 238 S HARDING CT |
Mailing Address - Street 2: | |
Mailing Address - City: | LOUISVILLE |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80027-9770 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 303-661-9216 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2687 NORTHPARK DR STE 103 |
Practice Address - Street 2: | |
Practice Address - City: | LAFAYETTE |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80026-3176 |
Practice Address - Country: | US |
Practice Address - Phone: | 303-661-9216 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2017-12-08 |
Last Update Date: | 2017-12-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CO | ACB.0008270 | 101YA0400X |
CO | LPC.0014126 | 101YM0800X, 106H00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |