MEDICARE: NICOLE MARIE HAMILTON-BRAHM LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	094612	IA

General Provider Information

NPI Number	:	1457117996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE MARIE HAMILTON-BRAHM LMHC

Provider Business Mailing Address
First Line	:	35 MARBLE CT SE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-6969
Country	:	US
Telephone Number	:	641-590-5405
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 MARBLE CT SE
Second Line	:
City	:	MASON CITY
State	:	IA
Zip	:	50401-6969
Country	:	US
Telephone Number	:	641-590-5405
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2024
Last Update Date	:	02/22/2024

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