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NPI Code Detail

MEDICARE: EMILY JAYNE HUMPHREYS BCBA, LBA

MEDICARE: EMILY JAYNE HUMPHREYS BCBA, LBA
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
1103K00000XBehavior Analyst1413TX

General Provider Information

NPI Number : 1528535556
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILY JAYNE HUMPHREYS BCBA, LBA
Provider Business Mailing Address
First Line : 12009 DERRINGER TRL
Second Line :
City : FORT WORTH
State : TX
Zip : 76108-1929
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4441 BRYANT IRVIN RD N
Second Line :
City : FORT WORTH
State : TX
Zip : 76107-7338
Country : US
Telephone Number : 817-944-4245
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2018
Last Update Date : 03/25/2026

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