Provider Demographics
NPI:1427811736
Name:HAMILTON, SUZETTE LEANN (CAS)
Entity type:Individual
Prefix:MS
First Name:SUZETTE
Middle Name:LEANN
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:CAS
Other - Prefix:
Other - First Name:SUZI
Other - Middle Name:LEANN
Other - Last Name:HAMILTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CAS
Mailing Address - Street 1:24194 ROAD L STE 2A
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-8959
Mailing Address - Country:US
Mailing Address - Phone:505-360-4933
Mailing Address - Fax:
Practice Address - Street 1:24194 ROAD L STE 2A
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-8959
Practice Address - Country:US
Practice Address - Phone:505-360-4933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0998610101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)