Provider Demographics
NPI:1013201326
Name:HUMPHRIES, DONNA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6447 PEDEN RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-9263
Mailing Address - Country:US
Mailing Address - Phone:817-287-9005
Mailing Address - Fax:
Practice Address - Street 1:6447 PEDEN RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76179-9263
Practice Address - Country:US
Practice Address - Phone:817-287-9005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-03
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional