Provider Demographics
NPI:1831454107
Name:HUMPHREY, AMENA ALICIA (LMHC, PHD, NCC)
Entity type:Individual
Prefix:MS
First Name:AMENA
Middle Name:ALICIA
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LMHC, PHD, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 IRMA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-3853
Mailing Address - Country:US
Mailing Address - Phone:321-274-3980
Mailing Address - Fax:407-244-1986
Practice Address - Street 1:734 IRMA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3853
Practice Address - Country:US
Practice Address - Phone:321-274-3980
Practice Address - Fax:407-244-1986
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 19309225200000X
FLMH23425101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant