Healthcare Provider Details

I. General information

NPI: 1215743703
Provider Name (Legal Business Name): JAMIE ELIZABETH HUMPHREY PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2024
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 20TH STREET SUITE 205
HUNTINGTON WV
25703-2071
US

IV. Provider business mailing address

1448 10TH AVENUE SUITE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-939-6487
  • Fax: 304-523-4358
Mailing address:
  • Phone: 304-691-6381
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1369
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: