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NPI Code Detail

MEDICARE: SHAWN HUMPHREYS

MEDICARE: SHAWN HUMPHREYS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency

General Provider Information

NPI Number : 1386241131
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHAWN HUMPHREYS
Provider Business Mailing Address
First Line : 3110 W CHEYENNE AVE STE 100
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-2254
Country : US
Telephone Number : 702-636-8729
Fax Number : 702-441-1808
Provider Business Practice Location Address
First Line : 3110 W CHEYENNE AVE STE 100
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-2254
Country : US
Telephone Number : 702-636-8729
Fax Number : 702-441-1808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2020
Last Update Date : 10/05/2020

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Directions to “ SHAWN HUMPHREYS ” Practice Location

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