Healthcare Provider Details

I. General information

NPI: 1093233520
Provider Name (Legal Business Name): CHRISTOPHER D HUMPHREY LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/30/2024
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 TYRONE PIKE
VERSAILLES KY
40383-1323
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 844-435-0900
  • Fax: 270-858-4029
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number280915
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: