Healthcare Provider Details

I. General information

NPI: 1952575680
Provider Name (Legal Business Name): MITCHELL DREW HUMPHRYS MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2008
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 SPYGLASS LANE
PASO ROBLES CA
93446
US

IV. Provider business mailing address

3013 SPYGLASS LANE
PASO ROBLES CA
93446
US

V. Phone/Fax

Practice location:
  • Phone: 805-400-7588
  • Fax:
Mailing address:
  • Phone: 805-400-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: