Provider Demographics
NPI:1528291275
Name:HUMPHREY, DANA FITCH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:FITCH
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SOUTHWESTERN BLVD STE 290
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3548
Mailing Address - Country:US
Mailing Address - Phone:281-914-6604
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTHWESTERN BLVD STE 290
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3548
Practice Address - Country:US
Practice Address - Phone:281-914-6604
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50881104100000X, 1041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker