Provider Demographics
NPI:1073671616
Name:UMPHRES, NANCY A (MED)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:UMPHRES
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 BLUE LAKE CIR
Mailing Address - Street 2:SUITE 248
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5132
Mailing Address - Country:US
Mailing Address - Phone:972-233-9067
Mailing Address - Fax:972-233-9067
Practice Address - Street 1:4141 BLUE LAKE CIR
Practice Address - Street 2:SUITE 248
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5132
Practice Address - Country:US
Practice Address - Phone:972-233-9067
Practice Address - Fax:972-233-9067
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11785101YP2500X
TX003372-040128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist