Provider Demographics
NPI:1922373828
Name:HUMPHREY, REBECCA A (LMHC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-2010
Mailing Address - Country:US
Mailing Address - Phone:765-474-4616
Mailing Address - Fax:
Practice Address - Street 1:1530 S 18TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-2010
Practice Address - Country:US
Practice Address - Phone:765-474-4616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001282A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health