Healthcare Provider Details

I. General information

NPI: 1114574217
Provider Name (Legal Business Name): KUMARA HAMPTON THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE MEDICO SUITE 4
SANTA FE NM
87505
US

IV. Provider business mailing address

1943 SAN ILDEFONSO
SANTA FE NM
87505
US

V. Phone/Fax

Practice location:
  • Phone: 505-903-8617
  • Fax:
Mailing address:
  • Phone: 505-903-8617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. KUMARA ELIAS HAMPTON
Title or Position: OWNER
Credential: MA, LPCC, LADAC
Phone: 505-903-8617