Provider Demographics
NPI:1386434769
Name:HUMPHREY, HOLLY HERRERA
Entity type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:HERRERA
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:831 E CONGRESSMAN SOLOMON P ORTIZ BLVD
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-6139
Mailing Address - Country:US
Mailing Address - Phone:361-815-3686
Mailing Address - Fax:
Practice Address - Street 1:11269 LEOPARD ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-2615
Practice Address - Country:US
Practice Address - Phone:361-693-5777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91561101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional