Healthcare Provider Details

I. General information

NPI: 1407025190
Provider Name (Legal Business Name): VERNA WAFER HUMPHREY LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 CRESTWOOD DR
DEER PARK TX
77536-3593
US

IV. Provider business mailing address

10412 SPENCER HWY
LA PORTE TX
77571-4300
US

V. Phone/Fax

Practice location:
  • Phone: 281-930-9119
  • Fax: 281-930-8683
Mailing address:
  • Phone: 832-276-4942
  • Fax: 281-542-9929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number34775
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34775
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: