Provider Demographics
NPI:1336328210
Name:PUMPHREY, EVELYN (LPC)
Entity Type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:
Last Name:PUMPHREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7481 N NAVAJO RD
Mailing Address - Street 2:
Mailing Address - City:FOX POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3463
Mailing Address - Country:US
Mailing Address - Phone:414-228-6419
Mailing Address - Fax:
Practice Address - Street 1:7481 N NAVAJO RD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3463
Practice Address - Country:US
Practice Address - Phone:414-228-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2269-125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39708100Medicaid