Provider Demographics
NPI:1487226759
Name:HUMPHRIES, JENNIFER JUNE (LMHC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JUNE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 GOLF COURSE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-4907
Mailing Address - Country:US
Mailing Address - Phone:810-513-2773
Mailing Address - Fax:
Practice Address - Street 1:2717 GOLF COURSE DR
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-4907
Practice Address - Country:US
Practice Address - Phone:810-513-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-15
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19388101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health