Provider Demographics
NPI:1851560841
Name:HUMBLE, MARY DOROTHY (LMSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:DOROTHY
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:DOROTHY
Other - Last Name:MCCLURE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1319 W MAY ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-3505
Mailing Address - Country:US
Mailing Address - Phone:316-267-2030
Mailing Address - Fax:316-267-2007
Practice Address - Street 1:1319 W MAY ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-3505
Practice Address - Country:US
Practice Address - Phone:316-267-2030
Practice Address - Fax:316-267-2007
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5204104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker