Provider Demographics
NPI:1467629808
Name:HUMPHRIES, LINDA M (MSW, EDD)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:M
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:MSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:842 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32301-0403
Mailing Address - Country:US
Mailing Address - Phone:850-656-2100
Mailing Address - Fax:850-656-2130
Practice Address - Street 1:842 E PARK AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-0403
Practice Address - Country:US
Practice Address - Phone:850-656-2100
Practice Address - Fax:850-656-2130
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional