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General NPI Number Information
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NPI Number | 1104096403
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Entity Type | Individual
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Provider Name | LYNN MARIEL HAMILTON M.A., LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/03/2008
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Last Update Date | 08/06/2009
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Provider Practice Location Address
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Address Line | 2620 WILMETTE AVE
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City | TITUSVILLE
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State | FL
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Zip | 32780-5135
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Country | US
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Telephone | 321-298-5817
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2216
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City | TITUSVILLE
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State | FL
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Zip | 32781-2216
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Country | US
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Telephone | 321-298-5817
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 9241
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License Number State | FL
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