Provider Demographics
NPI:1316144165
Name:HUMPHREY, COURTNEY M (BA)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 E NORTHRUP DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-5340
Mailing Address - Country:US
Mailing Address - Phone:405-243-3179
Mailing Address - Fax:
Practice Address - Street 1:409 E NORTHRUP DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-5340
Practice Address - Country:US
Practice Address - Phone:405-243-3179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health