Provider Demographics
NPI:1578912580
Name:HUMPHREY, RIISA (LPC-A, QMHP-R, NCC)
Entity Type:Individual
Prefix:
First Name:RIISA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPC-A, QMHP-R, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22866 HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:OR
Mailing Address - Zip Code:97419-9754
Mailing Address - Country:US
Mailing Address - Phone:541-505-2100
Mailing Address - Fax:
Practice Address - Street 1:1142 WILLAGILLESPIE RD STE 22
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6723
Practice Address - Country:US
Practice Address - Phone:541-505-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-09
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YM0800X
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)