MEDICARE: ANGELA D HUMPHREY LMHC

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	101YM0800X	Mental Health Counselor	39005661A	IN

General Provider Information

NPI Number	:	1184494346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA D HUMPHREY LMHC

Provider Business Mailing Address
First Line	:	505 N WABASH AVE
Second Line	:
City	:	MARION
State	:	IN
Zip	:	46952-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 E WASHINGTON ST
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-2210
Country	:	US
Telephone Number	:	765-348-1303
Fax Number	:

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

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	09/16/2025

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