Provider Demographics
NPI:1700506094
Name:HAMILTON, NANCY RUTH
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RUTH
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18213 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85023-6426
Mailing Address - Country:US
Mailing Address - Phone:480-322-7122
Mailing Address - Fax:602-375-9076
Practice Address - Street 1:700 E JEFFERSON ST STE 250
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85034-2204
Practice Address - Country:US
Practice Address - Phone:480-322-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ101YP1600X101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral