Provider Demographics
NPI:1013233170
Name:VERNA WAFER HUMPHREY
Entity Type:Organization
Organization Name:VERNA WAFER HUMPHREY
Other - Org Name:IN THE MASTER'S ARMS BOARDING &THERAPUTIC SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOCIAL WORKER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNA
Authorized Official - Middle Name:WAFER
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:832-276-4942
Mailing Address - Street 1:2705 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:TX
Mailing Address - Zip Code:77536-3593
Mailing Address - Country:US
Mailing Address - Phone:832-276-4942
Mailing Address - Fax:
Practice Address - Street 1:5402 HIRONDEL ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77033-3133
Practice Address - Country:US
Practice Address - Phone:832-276-4942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73445251B00000X, 251S00000X, 323P00000X
TX37445251S00000X, 320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1822843Medicaid