Provider Demographics
NPI:1548667926
Name:HUMPHREYS, BRANDY KITT (LPC)
Entity type:Individual
Prefix:MRS
First Name:BRANDY
Middle Name:KITT
Last Name:HUMPHREYS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14010 VINE RD
Mailing Address - Street 2:
Mailing Address - City:DIANA
Mailing Address - State:TX
Mailing Address - Zip Code:75640-3257
Mailing Address - Country:US
Mailing Address - Phone:903-746-3477
Mailing Address - Fax:
Practice Address - Street 1:3840 GILMER RD
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-1173
Practice Address - Country:US
Practice Address - Phone:903-746-3477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional