Provider Demographics
NPI:1194734707
Name:HAMPTON, LILLIE (LCSW)
Entity type:Individual
Prefix:
First Name:LILLIE
Middle Name:
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 1:12046 CANYON VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-7886
Mailing Address - Country:US
Mailing Address - Phone:281-255-4984
Mailing Address - Fax:281-255-4984
Practice Address - Street 1:12046 CANYON VALLEY DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377-7886
Practice Address - Country:US
Practice Address - Phone:281-255-4984
Practice Address - Fax:281-255-4984
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX411091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G5152Medicare PIN