Provider Demographics
NPI:1255351433
Name:HUMPHREYS, KATHLEEN (MSW, PLCSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:MSW, PLCSW
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:
Other - Last Name:HUMPHREYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23883 GRANITE AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63452-2462
Mailing Address - Country:US
Mailing Address - Phone:573-497-2484
Mailing Address - Fax:
Practice Address - Street 1:6000 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401
Practice Address - Country:US
Practice Address - Phone:573-248-5228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20050382181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical