Provider Demographics
NPI:1982768669
Name:HAMILTON, KATHLEEN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:KATSEANES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4601 S MUSTANG CREEK LN
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-5075
Mailing Address - Country:US
Mailing Address - Phone:208-870-2235
Mailing Address - Fax:
Practice Address - Street 1:4601 S MUSTANG CREEK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-5075
Practice Address - Country:US
Practice Address - Phone:208-870-2235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID277101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ5704Medicare UPIN
ID000010006980Medicare UPIN
KY277Medicare UPIN