Provider Demographics
NPI:1518937341
Name:HAMPTON, MARY KAREN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAREN
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 RESEARCH BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4388
Mailing Address - Country:US
Mailing Address - Phone:512-339-1694
Mailing Address - Fax:512-835-9677
Practice Address - Street 1:12741 RESEARCH BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4388
Practice Address - Country:US
Practice Address - Phone:512-339-1694
Practice Address - Fax:512-835-9677
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS39TMedicare ID - Type Unspecified