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General NPI Number Information
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NPI Number | 1104452507
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Entity Type | Individual
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Provider Name | JEREMY JAMES PUMPHREY MS-MFT, LAC
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Gender | Male
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Dates
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Enumeration Date | 03/17/2020
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 438 W SEED FARM RD,
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City | SACATON
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State | AZ
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Zip | 85147
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Country | US
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Telephone | 520-562-3321
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 38
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City | SACATON
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State | AZ
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Zip | 85147-0001
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Country | US
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Telephone | 520-562-3321
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-19679
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License Number State | AZ
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