Healthcare Provider Details

I. General information

NPI: 1750538484
Provider Name (Legal Business Name): SYDNEY NATOSHA HUMPHREY MSW, LCSW, RPT-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SYDNEY NATOSHA KELLETT MSW, LCSW, RPT-S

II. Dates (important events)

Enumeration Date: 08/25/2008
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 E. COURT ST.
ATOKA OK
74525
US

IV. Provider business mailing address

P.O. BOX 51
ATOKA OK
74525
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-0960
  • Fax:
Mailing address:
  • Phone: 580-889-0960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4514
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: