Provider Demographics
NPI:1578326245
Name:HAMPTON, DESTINY ELAINE
Entity Type:Individual
Prefix:
First Name:DESTINY
Middle Name:ELAINE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 W JASPER DR STE 9
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-1328
Mailing Address - Country:US
Mailing Address - Phone:254-265-8655
Mailing Address - Fax:
Practice Address - Street 1:1010 W JASPER DR STE 9
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1328
Practice Address - Country:US
Practice Address - Phone:254-265-8655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty