Provider Demographics
NPI:1407022528
Name:HAMILTON, ERVIN EUGENE (LLP)
Entity type:Individual
Prefix:MR
First Name:ERVIN
Middle Name:EUGENE
Last Name:HAMILTON
Suffix:
Gender:
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49081 YE OLDE WOODS
Mailing Address - Street 2:
Mailing Address - City:MATTAWAN
Mailing Address - State:MI
Mailing Address - Zip Code:49071-9702
Mailing Address - Country:US
Mailing Address - Phone:269-250-0247
Mailing Address - Fax:
Practice Address - Street 1:2775 W DICKMAN RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MI
Practice Address - Zip Code:49037-4895
Practice Address - Country:US
Practice Address - Phone:269-883-6560
Practice Address - Fax:269-883-6891
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-08
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301013743103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist