Healthcare Provider Details

I. General information

NPI: 1396999546
Provider Name (Legal Business Name): DERRICK HUMPHREY LIMHP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9222 BURT ST APT 121
OMAHA NE
68114-2429
US

IV. Provider business mailing address

9222 BURT ST APT 121
OMAHA NE
68114-2429
US

V. Phone/Fax

Practice location:
  • Phone: 402-926-9124
  • Fax:
Mailing address:
  • Phone: 402-926-9124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLIMHP-3133
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: