Healthcare Provider Details

I. General information

NPI: 1831136142
Provider Name (Legal Business Name): JENNIFER LYNN HUMPHRIES LCSW-ACP, PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC-JAPAN UNIT 45011, BLDG 704, ATTN: MCJA-QM
APO AP
96338-5011
JP

IV. Provider business mailing address

US ARMY MEDICAL DEPARTMENT ACTIVITY, JAPAN UNIT 45011, BLDG 704, ATTN: MCJA-QM
APO AP
96338-5011
JP

V. Phone/Fax

Practice location:
  • Phone: 01181464078206
  • Fax:
Mailing address:
  • Phone: 01181464078206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number35775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: