Basic Information
| Provider Information | |||||||||
| NPI: | 1861443624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMOND | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DON | ||||||||
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| Credential: | MS PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1378 34TH AVE NW | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035813241 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1675 WINTER ST NE | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035850351 | ||||||||
| FaxNumber: | 5035850212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | T0153 | OR | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | CO116 | OR | X | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.