Provider Demographics
NPI:1659483428
Name:HAMILTON, LARRY J (MFT)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:J
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23441 S POINTE DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1549
Mailing Address - Country:US
Mailing Address - Phone:949-707-1613
Mailing Address - Fax:949-452-0296
Practice Address - Street 1:23441 S POINTE DR
Practice Address - Street 2:SUITE 180
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1549
Practice Address - Country:US
Practice Address - Phone:949-707-1613
Practice Address - Fax:949-452-0296
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19466106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0004254630OtherAETNA
CA14009153230OtherHUMANA
CA260222225OtherBLUE CROSS
CA260222225002OtherCIGNA
CA1760692008OtherBLUE SHIELD
CA2225-01OtherPACIFICARE