Provider Demographics
NPI:1629322201
Name:HUMPHREY, KESHIA DANIELE
Entity Type:Individual
Prefix:
First Name:KESHIA
Middle Name:DANIELE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KESHIA
Other - Middle Name:DANIELE
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:43306 11TH ST E
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-4887
Mailing Address - Country:US
Mailing Address - Phone:661-525-3500
Mailing Address - Fax:
Practice Address - Street 1:43306 11TH ST E
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-4887
Practice Address - Country:US
Practice Address - Phone:661-525-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-02
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist