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NPI Code Detail

MEDICARE: MS. VANESSA HUMPHREY LCPC, NCC

MEDICARE: MS. VANESSA HUMPHREY LCPC, NCC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1629325642
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. VANESSA HUMPHREY LCPC, NCC
Provider Business Mailing Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 702-329-0148
Fax Number :
Provider Business Practice Location Address
First Line : 2620 REGATTA DR STE 102
Second Line :
City : LAS VEGAS
State : NV
Zip : 89128-6892
Country : US
Telephone Number : 702-329-0148
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2012
Last Update Date : 10/04/2022

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