1639312747 NPI number — MRS. HOLLY HAMPTON LPC

Table of content: MRS. HOLLY HAMPTON LPC (NPI 1639312747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639312747 NPI number — MRS. HOLLY HAMPTON LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAMPTON
Provider First Name:
HOLLY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WAGGONER
Provider Other First Name:
HOLLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639312747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
320 HIGHLAND DR
Provider Second Line Business Mailing Address:
PO BOX 597
Provider Business Mailing Address City Name:
MOUNTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17554-1232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-285-7121
Provider Business Mailing Address Fax Number:
717-285-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 NEW HOLLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17602-2137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-390-0353
Provider Business Practice Location Address Fax Number:
717-390-1812
Provider Enumeration Date:
04/20/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PC009464 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)