Provider Demographics
NPI:1245585876
Name:HUMPHREYS, CAROL MARIE (THD, MSW)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:THD, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:MITCHELL
Mailing Address - State:OR
Mailing Address - Zip Code:97750-0311
Mailing Address - Country:US
Mailing Address - Phone:541-575-1466
Mailing Address - Fax:
Practice Address - Street 1:528 E MAIN ST
Practice Address - Street 2:STE W
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845-1289
Practice Address - Country:US
Practice Address - Phone:541-575-1466
Practice Address - Fax:541-575-1411
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health