Provider Demographics
NPI:1487808143
Name:HUMPHREY, JILL CATHERINE (LPC, NBCC, MS,BA)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:CATHERINE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPC, NBCC, MS,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MAIN ST
Mailing Address - Street 2:4TH FLOOR ADMINISTRATION
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06702-2310
Mailing Address - Country:US
Mailing Address - Phone:203-574-9000
Mailing Address - Fax:203-574-9006
Practice Address - Street 1:141 E MAIN ST
Practice Address - Street 2:WELLMORE INC-3RD FLOOR
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06702-2310
Practice Address - Country:US
Practice Address - Phone:203-575-0456
Practice Address - Fax:203-575-1817
Is Sole Proprietor?:No
Enumeration Date:2008-11-07
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008037434Medicaid
CT4687873OtherCIGNA BEHAVIORAL HEALTH
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY
CTD339123 141 E MAINOtherBEACON HEALTH STRATEGIES
CT060669107OtherANTHEM BCBS OF CT WELLMORE GRP/FACILITY
CT060669107OtherHEALTHYCT WELLMORE GRP/FACILITY
CT539524OtherMHN MANAGED HEALTHCARE
CT9403704OtherAETNA BEHAVIORAL HEALTH
CTNBCC-62197OtherNATIONAL BOARD OF CERTIFIED COUNSELORS
CT060669107OtherOPTUM BEHAVIORAL HEALTH/UBH WELLMORE GRP/FACILITY
CT060669107OtherUBH-UNITED HEALTHCARE WELLMORE GRP/FACILITY
CT539524 PENDINGOtherMHN TRICARE NORTH
CT060669107OtherUBH- OXFORD FREEDOM/LIBERTY WELLMORE GRP/FACILITY
CT13540256OtherCAQH
CT060669107OtherUBH-CONNECTICARE WELLMORE GRP/FACILITY