Healthcare Provider Details

I. General information

NPI: 1487618310
Provider Name (Legal Business Name): CYNTHIA A HAMALA LICENSED PROFESSIONA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CREST ST
BURLINGTON WI
53105
US

IV. Provider business mailing address

2929 WYCLIFF AVE 2233
DALLAS TX
75219-2646
US

V. Phone/Fax

Practice location:
  • Phone: 262-767-0440
  • Fax: 262-767-0777
Mailing address:
  • Phone: 262-716-1825
  • Fax: 262-767-0777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3262125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: