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General NPI Number Information
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NPI Number | 1235359431
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Entity Type | Individual
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Provider Name | AMY D HUMPHREY LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 09/20/2011
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Provider Practice Location Address
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Address Line | 1115 HARBER RD.
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City | GROVE
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State | OK
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Zip | 74344
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Country | US
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Telephone | 918-786-4434
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Fax | 918-786-4435
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Provider Business Mailing Address
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Address Line | PO BOX 451385
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City | GROVE
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State | OK
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Zip | 74345-1385
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Country | US
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Telephone | 918-786-4434
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Fax | 918-786-4435
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3737
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License Number State | OK
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