Provider Demographics
NPI:1316283500
Name:HUMPHREY, TYRONE JR (MS)
Entity type:Individual
Prefix:MR
First Name:TYRONE
Middle Name:
Last Name:HUMPHREY
Suffix:JR
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7826 EVIAN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-9616
Mailing Address - Country:US
Mailing Address - Phone:317-590-0478
Mailing Address - Fax:
Practice Address - Street 1:7826 EVIAN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-9616
Practice Address - Country:US
Practice Address - Phone:317-590-0478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health