Provider Demographics
NPI:1356401129
Name:HUMPHREYS, ROBERT BRYAN (LCSW, ACSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:BRYAN
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:5600 BRAINERD RD STE A4
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5336
Practice Address - Country:US
Practice Address - Phone:423-266-4588
Practice Address - Fax:865-342-0103
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN48371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical