Provider Demographics
NPI:1831118454
Name:HAMILTON, KRISTINE ANN (MS, LPC-MH)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:MS, LPC-MH
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:ANN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC-MH
Mailing Address - Street 1:2121 W 63RD PL
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-5058
Mailing Address - Country:US
Mailing Address - Phone:605-373-9330
Mailing Address - Fax:605-373-9218
Practice Address - Street 1:2121 W 63RD PL
Practice Address - Street 2:SUITE #100
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-5058
Practice Address - Country:US
Practice Address - Phone:605-373-9330
Practice Address - Fax:605-373-9218
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC-MH2115101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6575982Medicaid