Provider Demographics
NPI:1427382886
Name:HAMILTON, NICOLE R
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:R
Other - Last Name:NUSSBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N EDISON ST STE 233
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1983
Mailing Address - Country:US
Mailing Address - Phone:509-987-1712
Mailing Address - Fax:509-987-1715
Practice Address - Street 1:201 N EDISON ST STE 233
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1983
Practice Address - Country:US
Practice Address - Phone:509-987-1712
Practice Address - Fax:509-987-1715
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60793216101YM0800X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2095070Medicaid