Provider Demographics
NPI:1790502102
Name:HAMILTON, MADISON (CSW, TLMHC)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:U
Credentials:CSW, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 BIXLER DR APT 1704
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88012-5113
Mailing Address - Country:US
Mailing Address - Phone:720-235-7796
Mailing Address - Fax:
Practice Address - Street 1:715 E IDAHO AVE STE 3E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-4702
Practice Address - Country:US
Practice Address - Phone:575-323-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCTB-2024-0673101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health