Healthcare Provider Details

I. General information

NPI: 1497032296
Provider Name (Legal Business Name): DENNIS R HUMPHREY LCPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2011
Last Update Date: 11/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 W. HIGGINS RD.
HOFFMAN ESTATES IL
60169-7209
US

IV. Provider business mailing address

524 SLINGERLAND
SCHAUMBURG IL
60193-2351
US

V. Phone/Fax

Practice location:
  • Phone: 847-302-4492
  • Fax:
Mailing address:
  • Phone: 847-302-4492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180002680
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: