=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215286463
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHELLE HAMILTON LMFT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/04/2012
-----------------------------------------------------
Last Update Date | 08/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9180 ESTERO PARK COMMONS BLVD UNIT 2
-----------------------------------------------------
City | ESTERO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33928-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-225-7773
-----------------------------------------------------
Fax | 239-495-7772
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9180 ESTERO PARK COMMONS BLVD UNIT 2
-----------------------------------------------------
City | ESTERO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33928-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-225-7773
-----------------------------------------------------
Fax | 239-495-7772
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PRESIDENT
-----------------------------------------------------
Name | MICHELLE HAMILTON
-----------------------------------------------------
Credential | LMFT
-----------------------------------------------------
Telephone | 239-495-7773
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MT1928
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------