Provider Demographics
NPI:1609243419
Name:HUMBLE, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 TROY ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:PA
Mailing Address - Zip Code:17724-1015
Mailing Address - Country:US
Mailing Address - Phone:570-980-4053
Mailing Address - Fax:
Practice Address - Street 1:359 TROY ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:PA
Practice Address - Zip Code:17724-1015
Practice Address - Country:US
Practice Address - Phone:570-980-4053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor