Provider Demographics
NPI:1821427006
Name:HUMPHREY, DYRENDA MURRAY (MA MFT BA PSYCHOLOGY)
Entity Type:Individual
Prefix:MS
First Name:DYRENDA
Middle Name:MURRAY
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MA MFT BA PSYCHOLOGY
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Mailing Address - Street 1:724 ROBERTA ALECIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-7970
Mailing Address - Country:US
Mailing Address - Phone:702-408-5052
Mailing Address - Fax:
Practice Address - Street 1:3925 N MLK BLVD STE 212
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89032-7676
Practice Address - Country:US
Practice Address - Phone:702-461-1982
Practice Address - Fax:702-644-6260
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV225400000X
NVM13032106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner