Provider Demographics
NPI:1669556932
Name:HAMILTON, TERESA LEIGH (LMHP,LADC)
Entity type:Individual
Prefix:MISS
First Name:TERESA
Middle Name:LEIGH
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LMHP,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 BRYAN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2863
Mailing Address - Country:US
Mailing Address - Phone:402-639-0435
Mailing Address - Fax:
Practice Address - Street 1:2809 BRYAN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-2863
Practice Address - Country:US
Practice Address - Phone:402-639-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE610101YA0400X
NE2503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025451100Medicaid