Provider Demographics
NPI:1679760185
Name:HAMILTON, MARY R (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:VAN BUREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:PO BOX 1727
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81502-1727
Mailing Address - Country:US
Mailing Address - Phone:970-644-4220
Mailing Address - Fax:970-263-4239
Practice Address - Street 1:2020 N 12TH ST
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2914
Practice Address - Country:US
Practice Address - Phone:970-644-4220
Practice Address - Fax:970-263-4239
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0014321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000163794Medicaid