Provider Demographics
NPI:1023528643
Name:HUMPHREY, TRACY LOUISE (MA, MSW)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:LOUISE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3289 HUNTER RD N
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8719
Mailing Address - Country:US
Mailing Address - Phone:901-351-5115
Mailing Address - Fax:
Practice Address - Street 1:3970 DESOTO AVE
Practice Address - Street 2:MCCORD HALL, 219
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125
Practice Address - Country:US
Practice Address - Phone:901-351-5115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health