MEDICARE: MRS. KAITLYN LOUISE HUMPHRIES MSW

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

General Provider Information

NPI Number	:	1871287417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAITLYN LOUISE HUMPHRIES MSW

Provider Business Mailing Address
First Line	:	1050 S 11TH ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4739
Country	:	US
Telephone Number	:	409-202-3107
Fax Number	:

Provider Business Practice Location Address
First Line	:	1050 S 11TH ST
Second Line	:
City	:	BEAUMONT
State	:	TX
Zip	:	77701-4739
Country	:	US
Telephone Number	:	409-202-3107
Fax Number	:

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

Provider Enumeration Date	:	06/06/2023
Last Update Date	:	09/29/2023

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