Provider Demographics
NPI:1992859532
Name:HUMPHREYS, LEWIS E (PSYCH)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:E
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34584
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1584
Mailing Address - Country:US
Mailing Address - Phone:509-241-7349
Mailing Address - Fax:509-241-7628
Practice Address - Street 1:15446 BEL RED RD
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5501
Practice Address - Country:US
Practice Address - Phone:425-883-5320
Practice Address - Fax:425-883-5178
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00000824103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8344574Medicaid
WAGAB28781Medicare PIN
WA8344574Medicaid