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Individual

MARK THEODORE HAMILTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
LLP

Contact information

Practice address
450 MEADOW RUN DR, HASTINGS, MI 49058-9053
(616) 891-8770
(616) 891-3504
Mailing address
300 68TH ST SE, GRAND RAPIDS, MI 49548-6927
(616) 455-5000

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
6301009792
MI
103T00000X
Psychologist
Primary
6361004091
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
BC/BS
P10D11275
MI
Enumeration date
06/30/2006
Last updated
03/22/2022
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