Provider Demographics
NPI:1407025190
Name:HUMPHREY, VERNA WAFER (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:VERNA
Middle Name:WAFER
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10412 SPENCER HWY
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-4300
Mailing Address - Country:US
Mailing Address - Phone:832-276-4942
Mailing Address - Fax:281-542-9929
Practice Address - Street 1:2705 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:TX
Practice Address - Zip Code:77536-3593
Practice Address - Country:US
Practice Address - Phone:281-930-9119
Practice Address - Fax:281-930-8683
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-26
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34775101YM0800X, 104100000X, 1041C0700X
101YM0800X, 101YP1600X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182284310Medicaid