Provider Demographics
NPI:1982920583
Name:HUMBLE, CHARLES CORBIN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:CORBIN
Last Name:HUMBLE
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 N PENIEL AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3402
Mailing Address - Country:US
Mailing Address - Phone:405-808-7180
Mailing Address - Fax:
Practice Address - Street 1:3908 N PENIEL AVE STE 500
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3402
Practice Address - Country:US
Practice Address - Phone:405-808-7180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2019-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200318120AMedicaid
OK200318120BMedicaid