Provider Demographics
NPI:1629451943
Name:HUMPHREY, BARBARA (MA,LCAC,CADACII)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MA,LCAC,CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6062 COUNTRYBROOK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1262
Mailing Address - Country:US
Mailing Address - Phone:317-291-8285
Mailing Address - Fax:
Practice Address - Street 1:6062 COUNTRYBROOK RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1262
Practice Address - Country:US
Practice Address - Phone:765-727-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-06
Last Update Date:2016-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN87001335A101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health