Provider Demographics
NPI:1497909204
Name:HAMILTON, LATRESSA GAIL (MHPP)
Entity Type:Individual
Prefix:
First Name:LATRESSA
Middle Name:GAIL
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:TRESSA
Other - Middle Name:GAIL
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MHPP
Mailing Address - Street 1:PO BOX 679
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-0679
Mailing Address - Country:US
Mailing Address - Phone:501-354-4589
Mailing Address - Fax:501-354-5410
Practice Address - Street 1:100 S CHEROKEE ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-2656
Practice Address - Country:US
Practice Address - Phone:501-354-4589
Practice Address - Fax:501-354-5410
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst