Provider Demographics
NPI:1356621841
Name:HAMILTON, CHANNING D
Entity type:Individual
Prefix:MR
First Name:CHANNING
Middle Name:D
Last Name:HAMILTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 NW 32ND ST
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-4226
Mailing Address - Country:US
Mailing Address - Phone:405-312-9067
Mailing Address - Fax:
Practice Address - Street 1:900 NW 10TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-7220
Practice Address - Country:US
Practice Address - Phone:405-528-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-28
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst