Provider Demographics
NPI:1912322041
Name:HUMPHREY, DANIEL LEE
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:LEE
Last Name:HUMPHREY
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DANIEL
Other - Middle Name:LEE
Other - Last Name:HUMPHREY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RI-H1301071139
Mailing Address - Street 1:PO BOX 91
Mailing Address - Street 2:
Mailing Address - City:HAYFORK
Mailing Address - State:CA
Mailing Address - Zip Code:96041-0091
Mailing Address - Country:US
Mailing Address - Phone:530-628-4111
Mailing Address - Fax:530-628-1982
Practice Address - Street 1:154 TULE CREEK ROAD
Practice Address - Street 2:
Practice Address - City:HAYFORK
Practice Address - State:CA
Practice Address - Zip Code:96041
Practice Address - Country:US
Practice Address - Phone:530-628-4111
Practice Address - Fax:530-628-1982
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-H1301071139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)