Provider Demographics
NPI:1508963323
Name:HAMILTON, PHILLIP A (LCSW LAC)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:A
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LCSW LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BROADWAY
Mailing Address - Street 2:STE 402
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802
Mailing Address - Country:US
Mailing Address - Phone:406-546-7956
Mailing Address - Fax:
Practice Address - Street 1:101 E BROADWAY
Practice Address - Street 2:STE 402
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802
Practice Address - Country:US
Practice Address - Phone:406-546-7956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT916101YA0400X
MT608LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical