Provider Demographics
NPI:1710049879
Name:HAMPTON, FRED GERALD (LCSW)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:GERALD
Last Name:HAMPTON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 STORY AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-1735
Mailing Address - Country:US
Mailing Address - Phone:502-584-1369
Mailing Address - Fax:502-585-3989
Practice Address - Street 1:1425 STORY AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-1735
Practice Address - Country:US
Practice Address - Phone:502-584-1369
Practice Address - Fax:502-585-3989
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY521101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health