Provider Demographics
NPI:1891292371
Name:HAMILTON, JOHNATHAN DERRELL SR (BCBA)
Entity type:Individual
Prefix:MR
First Name:JOHNATHAN
Middle Name:DERRELL
Last Name:HAMILTON
Suffix:SR
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OK
Mailing Address - Zip Code:74020-3421
Mailing Address - Country:US
Mailing Address - Phone:539-209-1209
Mailing Address - Fax:539-203-3673
Practice Address - Street 1:303 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OK
Practice Address - Zip Code:74020-3421
Practice Address - Country:US
Practice Address - Phone:539-209-1209
Practice Address - Fax:539-203-3672
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-10
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
OK1-20-44279103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician