MEDICARE: NANCY A UMPHRES M.ED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	11785	TX
2	106H00000X	Marriage & Family Therapist	003372-040128	TX

General Provider Information

NPI Number	:	1073671616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY A UMPHRES M.ED

Provider Business Mailing Address
First Line	:	4141 BLUE LAKE CIR
Second Line	:	SUITE 248
City	:	DALLAS
State	:	TX
Zip	:	75244-5132
Country	:	US
Telephone Number	:	972-233-9067
Fax Number	:	972-233-9067

Provider Business Practice Location Address
First Line	:	4141 BLUE LAKE CIR
Second Line	:	SUITE 248
City	:	DALLAS
State	:	TX
Zip	:	75244-5132
Country	:	US
Telephone Number	:	972-233-9067
Fax Number	:	972-233-9067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	09/11/2025

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