Provider Demographics
NPI:1346995172
Name:HUMPHREY, PATRICK TYLER ROBIN
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:TYLER ROBIN
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 PIONEER TRL
Mailing Address - Street 2:
Mailing Address - City:CEDAR SPRINGS
Mailing Address - State:MI
Mailing Address - Zip Code:49319-8136
Mailing Address - Country:US
Mailing Address - Phone:616-251-8162
Mailing Address - Fax:
Practice Address - Street 1:421 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:CEDAR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49319-8136
Practice Address - Country:US
Practice Address - Phone:616-251-8162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician