Basic Information
| Provider Information | |||||||||
| NPI: | 1710275961 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMLIN | ||||||||
| FirstName: | KELLY | ||||||||
| MiddleName: | LORENE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KRUPP | ||||||||
| OtherFirstName: | KELLY | ||||||||
| OtherMiddleName: | LORENE HAMLIN | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LPCC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2600 YALE BLVD SE | ||||||||
| Address2: | UNMH - ASAP | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059947999 | ||||||||
| FaxNumber: | 5052430366 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 YALE BLVD SE | ||||||||
| Address2: | UNMH - ASAP | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871064217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5059947999 | ||||||||
| FaxNumber: | 5052430366 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2011 | ||||||||
| LastUpdateDate: | 01/31/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0003598 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 0153261 | NM | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.