Provider Demographics
NPI:1891856696
Name:HUMPHREYS, SANDY ANN MARSHALL (LPC LMFT)
Entity type:Individual
Prefix:MRS
First Name:SANDY
Middle Name:ANN MARSHALL
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LPC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 FERN AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4984
Mailing Address - Country:US
Mailing Address - Phone:318-629-0152
Mailing Address - Fax:318-629-0157
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:SUITE 404
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4971
Practice Address - Country:US
Practice Address - Phone:318-797-0084
Practice Address - Fax:318-797-0844
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LALPC2765101YP2500X
LA935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist