Healthcare Provider Details

I. General information

NPI: 1437504958
Provider Name (Legal Business Name): KUMARA ELIAS HAMPTON MA, LPCC, LADAC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2016
Last Update Date: 08/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 CALLE MEDICO SWEET 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 Number0180331
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0187601
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCCMH0205181
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: