Provider Demographics
NPI:1649058736
Name:MICHAEL HUMPHRIES M.S.CCC-SLP, BCBA & ASSOCIATES PLLC
Entity type:Organization
Organization Name:MICHAEL HUMPHRIES M.S.CCC-SLP, BCBA & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:HUMPHRIES
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, BCBA
Authorized Official - Phone:405-652-9683
Mailing Address - Street 1:3812 WEDGEWOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73179-1282
Mailing Address - Country:US
Mailing Address - Phone:405-652-9683
Mailing Address - Fax:
Practice Address - Street 1:9031 SW 29TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73179-2818
Practice Address - Country:US
Practice Address - Phone:405-464-8484
Practice Address - Fax:405-883-3061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty