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General NPI Number Information
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NPI Number | 1104237650
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Entity Type | Individual
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Provider Name | MR. MICHAEL RAY HAMILTON SR.
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Gender | Male
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Dates
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Enumeration Date | 05/17/2014
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Last Update Date | 06/04/2018
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Provider Practice Location Address
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Address Line | 201 LESSARD ST
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City | DONALDSONVILLE
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State | LA
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Zip | 70346-2507
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Country | US
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Telephone | 225-257-4677
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Fax |
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Provider Business Mailing Address
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Address Line | 850 KALISTE SALOOM RD STE 117
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City | LAFAYETTE
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State | LA
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Zip | 70508-4230
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Country | US
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Telephone | 337-234-7109
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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 | 1307
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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