Provider Demographics
NPI:1831136142
Name:HUMPHRIES, JENNIFER LYNN (LCSW-ACP, PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:LCSW-ACP, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:US ARMY MEDICAL DEPARTMENT ACTIVITY, JAPAN
Mailing Address - Street 2:UNIT 45011, BLDG 704, ATTN: MCJA-QM
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96338-5011
Mailing Address - Country:JP
Mailing Address - Phone:0118146-407-8206
Mailing Address - Fax:
Practice Address - Street 1:USA MEDDAC-JAPAN
Practice Address - Street 2:UNIT 45011, BLDG 704, ATTN: MCJA-QM
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338-5011
Practice Address - Country:JP
Practice Address - Phone:0118146-407-8206
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX357751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical