Provider Demographics
NPI:1053683904
Name:HAMPTON, BRETT L (LMSW)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:L
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1970 E 17TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-8048
Mailing Address - Country:US
Mailing Address - Phone:208-523-5319
Mailing Address - Fax:208-523-5627
Practice Address - Street 1:1970 E 17TH ST STE 202
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-8048
Practice Address - Country:US
Practice Address - Phone:208-523-5319
Practice Address - Fax:208-523-5627
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-28497104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker