Provider Demographics
NPI:1629300439
Name:HAMPTON, VICKY ELAINE (LADC, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:ELAINE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:LADC, LPC, NCC
Other - Prefix:
Other - First Name:VICKY
Other - Middle Name:HAMPTON
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC, LPC
Mailing Address - Street 1:16216 OSCEOLA TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1260
Mailing Address - Country:US
Mailing Address - Phone:405-777-9459
Mailing Address - Fax:405-513-6383
Practice Address - Street 1:16301 SONOMA PARK DR
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2091
Practice Address - Country:US
Practice Address - Phone:405-777-9459
Practice Address - Fax:405-758-5975
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK470101YA0400X
VA0701003989101YP2500X
OK3857101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1629300439Other101YP2500X - COUNSELOR PROFESSIONAL
OK200288700AMedicaid
OK200288700BMedicaid
OK1629300439Other101YA0400X - COUNSELOR - ADDICTION (SUBTANCE USE DISORDER)