Healthcare Provider Details

I. General information

NPI: 1043437783
Provider Name (Legal Business Name): TOM HUMPHREYS LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 10/24/2023
Certification Date: 10/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 9TH AVE
SEATTLE WA
98104-2420
US

IV. Provider business mailing address

325 9TH AVE # 359797
SEATTLE WA
98104-2420
US

V. Phone/Fax

Practice location:
  • Phone: 206-744-9600
  • Fax: 206-744-9914
Mailing address:
  • Phone: 206-744-9600
  • Fax: 206-744-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH00009902
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: