Provider Demographics
NPI:1891703435
Name:HUMMERT, HENRY (PH D)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:HUMMERT
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 OLD FRONTENAC SQ
Mailing Address - Street 2:STE 201
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-2754
Mailing Address - Country:US
Mailing Address - Phone:314-993-3323
Mailing Address - Fax:314-993-5424
Practice Address - Street 1:745 OLD FRONTENAC SQ
Practice Address - Street 2:STE 201
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2754
Practice Address - Country:US
Practice Address - Phone:314-993-3323
Practice Address - Fax:314-993-5424
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPYR0188103T00000X
IL103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist