Provider Demographics
NPI:1912563297
Name:HUMPHRIES, GARRETT (MA)
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:
Last Name:HUMPHRIES
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S JEFFERSON ST STE 114
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-3100
Mailing Address - Country:US
Mailing Address - Phone:509-850-0662
Mailing Address - Fax:
Practice Address - Street 1:400 S JEFFERSON ST STE 114
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3100
Practice Address - Country:US
Practice Address - Phone:509-850-0662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61361608101YM0800X
171M00000X
WAMG61354283106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator