Provider Demographics
NPI:1477633956
Name:HUMPHREY, SEAN PATRICK (MA LMHC CDP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:PATRICK
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:MA LMHC CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:635 SW 154TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2220
Mailing Address - Country:US
Mailing Address - Phone:206-403-7769
Mailing Address - Fax:
Practice Address - Street 1:635 SW 154TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2220
Practice Address - Country:US
Practice Address - Phone:206-403-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00002543101YA0400X
WALH00007674101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)