Provider Demographics
NPI:1780691626
Name:HUMBERD, THOMAS RUSSELL (MS LPC MHSP)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:HUMBERD
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Gender:M
Credentials:MS LPC MHSP
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Mailing Address - Street 1:5410 HOMBERG DRIVE
Mailing Address - Street 2:STE 14
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-588-3173
Mailing Address - Fax:865-588-3174
Practice Address - Street 1:5410 HOMBERG DRIVE
Practice Address - Street 2:STE 14
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-588-3173
Practice Address - Fax:865-588-3174
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001609101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
244504OtherCOMPSYCH
9375370OtherPRINCIPLE GROUP LIFE
1220955OtherCHA HEALTH
9375370OtherPRIVATE HEALTH CARE SYSTE
4105431OtherBLUE CROSS BLUE SHIELD
TN0104OtherJOHN DEERE HEALTH
359710OtherMANAGED HEALTH NETWORK