Doctor Name: | CAROL MARIE HUMPHREYS |
NPI Number: | 1245585876 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | TH.D., MSW |
License Number: | |
Business Practice Address: | 528 E Main St Ste W John Day, OR - 978451289 |
Business Phone Number: | 5415751466 |
Business Fax Number: | 5415751411 |
Mailing Address: | Po Box 311, MITCHELL |
State: | OR |
Postal Code: | 977500311 |
Phone Number: | 5415751466 |
Fax Number: | |
NPI Enumeration Date: | 07/19/2012 |
NPI Last Update Date: | 07/19/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |