Provider Demographics
NPI:1568057016
Name:HAMILTON, LESLEY ALINE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:LESLEY
Middle Name:ALINE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3112 NEBRASKA ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-6213
Mailing Address - Country:US
Mailing Address - Phone:806-570-6774
Mailing Address - Fax:
Practice Address - Street 1:3112 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-6213
Practice Address - Country:US
Practice Address - Phone:806-570-6774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18070101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty