Provider Demographics
NPI:1861691040
Name:HAMILTON, HOLLY K (LCSW)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:K
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:896 DEER HOLLOW CT
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3169
Mailing Address - Country:US
Mailing Address - Phone:435-882-5100
Mailing Address - Fax:
Practice Address - Street 1:896 DEER HOLLOW CT
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-3169
Practice Address - Country:US
Practice Address - Phone:435-882-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT340452-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT340452-3501OtherDIVISION OF PROFESSIONAL