Provider Demographics
NPI:1275843435
Name:HUMPHREY, TRACY (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:799 ROOSEVELT RD
Mailing Address - Street 2:BLDG 4-303
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5908
Mailing Address - Country:US
Mailing Address - Phone:630-306-3907
Mailing Address - Fax:
Practice Address - Street 1:799 ROOSEVELT RD
Practice Address - Street 2:BLDG 4-303
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5908
Practice Address - Country:US
Practice Address - Phone:630-306-3907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.002682101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional