Provider Demographics
NPI:1720211584
Name:HAMILTON, MICHAEL R (LPC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12740 HILLCREST RD
Mailing Address - Street 2:STE 228
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2038
Mailing Address - Country:US
Mailing Address - Phone:214-417-1655
Mailing Address - Fax:
Practice Address - Street 1:12740 HILLCREST RD
Practice Address - Street 2:STE 228
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2038
Practice Address - Country:US
Practice Address - Phone:214-417-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional