Provider Demographics
NPI:1518935238
Name:HUMPHREYS, JOHN H (LCSW)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:SUITE 398
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4088
Mailing Address - Country:US
Mailing Address - Phone:503-742-5300
Mailing Address - Fax:503-742-5301
Practice Address - Street 1:524 MAIN ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1824
Practice Address - Country:US
Practice Address - Phone:503-655-8558
Practice Address - Fax:503-655-8197
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL13671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR93819Medicare UPIN
OR080WCGMWUMedicare ID - Type Unspecified