MEDICARE: MR. THOMAS HUMPHREY LCSW

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
1	1041C0700X	Clinical Social Worker	1920	KS

General Provider Information

NPI Number	:	1578935441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS HUMPHREY LCSW

Provider Business Mailing Address
First Line	:	400 E RED BRIDGE RD STE 203
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4030
Country	:	US
Telephone Number	:	816-678-9392
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 E RED BRIDGE RD STE 203
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64131-4030
Country	:	US
Telephone Number	:	816-678-9392
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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