Provider Demographics
NPI:1073084828
Name:PUMPHREY, JONATHAN (LMSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:PUMPHREY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 MEADOWVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:TX
Mailing Address - Zip Code:76210-4114
Mailing Address - Country:US
Mailing Address - Phone:817-403-7870
Mailing Address - Fax:
Practice Address - Street 1:105 KATHRYN DR STE 3A
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4216
Practice Address - Country:US
Practice Address - Phone:972-724-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker