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General NPI Number Information
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NPI Number | 1891292371
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Entity Type | Individual
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Provider Name | JOHNATHAN DERRELL HAMILTON SR. BCBA
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Gender | Male
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 303 N BROADWAY ST
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City | CLEVELAND
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State | OK
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Zip | 74020-3421
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Country | US
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Telephone | 539-209-1209
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Fax | 539-203-3672
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Provider Business Mailing Address
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Address Line | 303 N BROADWAY ST
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City | CLEVELAND
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State | OK
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Zip | 74020-3421
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Country | US
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Telephone | 539-209-1209
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Fax | 539-203-3673
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-20-44279
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License Number State | OK
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