Healthcare Provider Details

I. General information

NPI: 1700352754
Provider Name (Legal Business Name): JULIA HUMPHREVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 NE GLISAN ST
PORTLAND OR
97232-2844
US

IV. Provider business mailing address

4940 SE CARUTHERS ST
PORTLAND OR
97215-3833
US

V. Phone/Fax

Practice location:
  • Phone: 503-230-9654
  • Fax:
Mailing address:
  • Phone: 860-908-9280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18-P-20
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberL164664
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: