Provider Demographics
NPI:1497112650
Name:HAMILTON, TANYA
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 PIKE AVE
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-3135
Mailing Address - Country:US
Mailing Address - Phone:719-371-5885
Mailing Address - Fax:
Practice Address - Street 1:3691 PARKER BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2278
Practice Address - Country:US
Practice Address - Phone:719-545-2746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-19
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0012719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health