Provider Demographics
NPI:1376638346
Name:HUMPHREY, DENISE T (PHD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:T
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6320 LYNDON B JOHNSON FWY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75240-6472
Mailing Address - Country:US
Mailing Address - Phone:972-239-2490
Mailing Address - Fax:972-386-7395
Practice Address - Street 1:6320 LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 221
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6472
Practice Address - Country:US
Practice Address - Phone:972-239-2490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32345103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist