Provider Demographics
NPI:1871482067
Name:HUMPHREYS, KEITH (PHD)
Entity type:Individual
Prefix:PROF
First Name:KEITH
Middle Name:
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N. QUARRY ROAD
Mailing Address - Street 2:MAIL CODE 5717
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305
Mailing Address - Country:US
Mailing Address - Phone:650-723-9067
Mailing Address - Fax:
Practice Address - Street 1:401 N. QUARRY ROAD
Practice Address - Street 2:MAIL CODE 5717
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305
Practice Address - Country:US
Practice Address - Phone:650-723-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14906103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral