1891856696 NPI number — MRS. SANDY ANN MARSHALL HUMPHREYS LPC LMFT

Table of content: MRS. SANDY ANN MARSHALL HUMPHREYS LPC LMFT (NPI 1891856696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891856696 NPI number — MRS. SANDY ANN MARSHALL HUMPHREYS LPC LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUMPHREYS
Provider First Name:
SANDY
Provider Middle Name:
ANN MARSHALL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891856696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7330 FERN AVE STE 602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHREVEPORT
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71105-4984
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-629-0152
Provider Business Mailing Address Fax Number:
318-629-0157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7330 FERN AVE
Provider Second Line Business Practice Location Address:
SUITE 404
Provider Business Practice Location Address City Name:
SHREVEPORT
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71105-4971
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-797-0084
Provider Business Practice Location Address Fax Number:
318-797-0844
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC2765 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 935 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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