Provider Demographics
NPI:1497114565
Name:HUMPHREYS, SAMANTHA JOAN (LCDC)
Entity Type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:JOAN
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E EDINBURG AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543
Mailing Address - Country:US
Mailing Address - Phone:956-567-2026
Mailing Address - Fax:956-567-2027
Practice Address - Street 1:701 E EDINBURG AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-3002
Practice Address - Country:US
Practice Address - Phone:956-567-2026
Practice Address - Fax:956-567-2027
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13266101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)