MEDICARE: DR. TERRESA MARIE HUMPHRIES-WADSWORTH PH.D.

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	103TC0700X	Clinical Psychologist	407	WY
2	103TC1900X	Counseling Psychologist	407	WY

General Provider Information

NPI Number	:	1811155880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRESA MARIE HUMPHRIES-WADSWORTH PH.D.

Provider Business Mailing Address
First Line	:	6900 ALDEN DR
Second Line	:
City	:	FE WARREN AFB
State	:	WY
Zip	:	82005-2945
Country	:	US
Telephone Number	:	307-773-2539
Fax Number	:

Provider Business Practice Location Address
First Line	:	6900 ALDEN DR
Second Line	:
City	:	FE WARREN AFB
State	:	WY
Zip	:	82005-2945
Country	:	US
Telephone Number	:	307-773-2539
Fax Number	:

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

Provider Enumeration Date	:	05/27/2008
Last Update Date	:	08/04/2025

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