Provider Demographics
NPI:1932384716
Name:HUMPHREYS, ANNIE COLEMAN (MA, LPC, CACIII)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:COLEMAN
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:MA, LPC, CACIII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7820 INVERNESS BLVD UNIT 301
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5714
Mailing Address - Country:US
Mailing Address - Phone:303-257-7007
Mailing Address - Fax:
Practice Address - Street 1:7820 INVERNESS BLVD UNIT 301
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5714
Practice Address - Country:US
Practice Address - Phone:303-257-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CO0020851101YA0400X
CO0012918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)