Provider Demographics
NPI:1144601188
Name:HAMPTON, MARK W
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 WILDWOOD
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1803
Mailing Address - Country:US
Mailing Address - Phone:405-481-3436
Mailing Address - Fax:405-275-5132
Practice Address - Street 1:1010 E 45TH ST
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-2202
Practice Address - Country:US
Practice Address - Phone:405-273-1170
Practice Address - Fax:405-275-5132
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor