Healthcare Provider Details

I. General information

NPI: 1790502102
Provider Name (Legal Business Name): OLIVER HAMILTON LMHC, LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 5TH ST STE 100
SANTA FE NM
87505-5403
US

IV. Provider business mailing address

2501 W ZIA RD APT 5104
SANTA FE NM
87505-5756
US

V. Phone/Fax

Practice location:
  • Phone: 505-955-0410
  • Fax: 505-955-8577
Mailing address:
  • Phone: 720-235-7796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCTB-2025-0628
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: