Provider Demographics
NPI:1962798850
Name:HUMPHREY, DIANNA PATRICIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:DIANNA
Middle Name:PATRICIA
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:DIANNA
Other - Middle Name:PATRICIA
Other - Last Name:HAMMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1950 N OKMULGEE
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-6534
Mailing Address - Country:US
Mailing Address - Phone:918-756-7700
Mailing Address - Fax:918-756-3347
Practice Address - Street 1:1950 N OKMULGEE
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-6534
Practice Address - Country:US
Practice Address - Phone:918-756-7700
Practice Address - Fax:918-756-3347
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker