Provider Demographics
NPI:1063933976
Name:HUMPHREY, MISTY (LPC)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1911
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-1912
Mailing Address - Country:US
Mailing Address - Phone:620-675-0040
Mailing Address - Fax:844-645-1452
Practice Address - Street 1:801 N MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-5436
Practice Address - Country:US
Practice Address - Phone:620-675-0040
Practice Address - Fax:844-645-1452
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional