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General NPI Number Information
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NPI Number | 1548952070
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Entity Type | Individual
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Provider Name | ELIZABETH HUMPHREY LPC
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Gender | Female
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Dates
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Enumeration Date | 05/23/2023
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 215 N COLLEGE AVE
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City | FAYETTEVILLE
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State | AR
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Zip | 72701-4238
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Country | US
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Telephone | 479-879-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 158 N CENTENNIAL AVE
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City | WEST FORK
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State | AR
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Zip | 72774-2702
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Country | US
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Telephone | 479-879-1343
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Fax | 479-435-6276
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P2305011
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License Number State | AR
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