Provider Demographics
NPI:1568637338
Name:HUMPHRIES, ERIN GAYLE (LPC)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:GAYLE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 833
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-0833
Mailing Address - Country:US
Mailing Address - Phone:817-703-8768
Mailing Address - Fax:940-387-6274
Practice Address - Street 1:914 N LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2954
Practice Address - Country:US
Practice Address - Phone:940-387-6250
Practice Address - Fax:940-387-6274
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61635101YP2500X
TX201047106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1957284Medicaid