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General NPI Number Information
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NPI Number | 1730626664
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Entity Type | Organization
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Legal Business Name | HUMPHREYS COUNSELING
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 108 E CENTRAL AVE STE 210
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City | BENTONVILLE
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State | AR
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Zip | 72712-5396
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Country | US
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Telephone | 479-595-9920
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Fax |
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Provider Business Mailing Address
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Address Line | 4371 W CASTLEBURY LN
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City | FAYETTEVILLE
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State | AR
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Zip | 72704-6607
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Country | US
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Telephone | 479-595-9920
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. JAMES BRANDON HUMPHREYS
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Credential | L.P.C.
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Telephone | 479-595-9920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P1607093
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License Number State | AR
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