Provider Demographics
NPI:1386247153
Name:HAMILTON, TINA (LPCI)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11282 NW LISTER AVE
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-9046
Mailing Address - Country:US
Mailing Address - Phone:208-740-7193
Mailing Address - Fax:
Practice Address - Street 1:11282 NW LISTER AVE
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-9046
Practice Address - Country:US
Practice Address - Phone:208-740-7193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR6504101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health