Healthcare Provider Details

I. General information

NPI: 1780330894
Provider Name (Legal Business Name): SOPHIA KIMBELL HAMPTON BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SOPHIA KIMBELL HAMPTON

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 ALEXA DR STE E
MT STERLING KY
40353-1000
US

IV. Provider business mailing address

805 ALEXA DR STE E
MT STERLING KY
40353-1000
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax:
Mailing address:
  • Phone: 855-444-5664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number289174
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: