Provider Demographics
NPI:1083265896
Name:HUMPHREYS, KAYLI OLIVIA (LCSW)
Entity type:Individual
Prefix:
First Name:KAYLI
Middle Name:OLIVIA
Last Name:HUMPHREYS
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 ARMSTRONG LN
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-5013
Mailing Address - Country:US
Mailing Address - Phone:208-406-0526
Mailing Address - Fax:
Practice Address - Street 1:2413 ARMSTRONG LN
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-5013
Practice Address - Country:US
Practice Address - Phone:208-406-0526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-23
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR12432-C101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health