Provider Demographics
NPI:1386188852
Name:HUMPHREY, RACHEL T (MED)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:T
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:RAY
Other - Middle Name:T
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:3615 NE GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2104
Mailing Address - Country:US
Mailing Address - Phone:503-281-1166
Mailing Address - Fax:
Practice Address - Street 1:3615 NE GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2104
Practice Address - Country:US
Practice Address - Phone:503-281-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-18
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health