Provider Demographics
NPI:1093068033
Name:HUMPHREY, AMY A'DELL (LMFT)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A'DELL
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 AVENUE I
Mailing Address - Street 2:SUITE #11
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5619
Mailing Address - Country:US
Mailing Address - Phone:310-702-8355
Mailing Address - Fax:
Practice Address - Street 1:205 AVENUE I
Practice Address - Street 2:SUITE #11
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5619
Practice Address - Country:US
Practice Address - Phone:310-702-8355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31637106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist