Provider Demographics
NPI:1386423150
Name:HUMPHREYS, JERRY KAY JR
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:KAY
Last Name:HUMPHREYS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 FOREST ACRES DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37220-2100
Mailing Address - Country:US
Mailing Address - Phone:615-429-4467
Mailing Address - Fax:
Practice Address - Street 1:5405 FOREST ACRES DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37220-2100
Practice Address - Country:US
Practice Address - Phone:615-429-4467
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-21
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral