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General NPI Number Information
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NPI Number | 1891377974
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Entity Type | Organization
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Legal Business Name | EDWARD SCOTT HAMILTON PH D PLLC DISTRUPTIVE CHRISTIAN LEADERSHIP
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Dates
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Enumeration Date | 04/27/2021
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 710 LAMAR ST STE 440A
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City | WICHITA FALLS
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State | TX
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Zip | 76301-6837
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Country | US
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Telephone | 940-247-0595
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Fax |
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Provider Business Mailing Address
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Address Line | 208 POPLAR ST # T
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City | NOCONA
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State | TX
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Zip | 76255-1212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD SCOTT HAMILTON
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Credential |
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Telephone | 940-247-0595
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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