Provider Demographics
NPI:1073882676
Name:HAMPSON, PARKER G (LPC)
Entity Type:Individual
Prefix:MR
First Name:PARKER
Middle Name:G
Last Name:HAMPSON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FARVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1831
Mailing Address - Country:US
Mailing Address - Phone:203-470-4637
Mailing Address - Fax:
Practice Address - Street 1:425 GRANT ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3222
Practice Address - Country:US
Practice Address - Phone:203-337-9943
Practice Address - Fax:203-337-9986
Is Sole Proprietor?:No
Enumeration Date:2011-12-28
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001259101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038185Medicaid
CT008042339Medicaid
CT008023170Medicaid
CT008024427Medicaid