Provider Demographics
NPI:1457703274
Name:HAMILTON, CRYSTAL (BCBA)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 RIDGE LEAF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2506
Mailing Address - Country:US
Mailing Address - Phone:210-885-9082
Mailing Address - Fax:
Practice Address - Street 1:3201 CHERRY RIDGE ST
Practice Address - Street 2:SUITE B205
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-685-2266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-16-22710103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1-16-22710OtherBACB