Provider Demographics
NPI:1457480485
Name:HAMPTON, PAULINE MARIE (LPHA, LMHC)
Entity Type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:MARIE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LPHA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 HOLIDAY LN
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:IA
Mailing Address - Zip Code:52211-9537
Mailing Address - Country:US
Mailing Address - Phone:641-990-1569
Mailing Address - Fax:641-522-3125
Practice Address - Street 1:1297 HOLIDAY LN
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:IA
Practice Address - Zip Code:52211-9537
Practice Address - Country:US
Practice Address - Phone:641-990-1569
Practice Address - Fax:641-522-3125
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2021-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001030101YM0800X, 101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA600676531Medicaid
IA101199OtherLMHC
IA12505168OtherCAQH
IA01101OtherIOWA LICENSE
IA600676531Medicaid