Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TR0400X | Rehabilitation Psychologist | ||
Y | 1041C0700X | Clinical Social Worker | 4514 | OK |
NPI | 1750538484 |
---|---|
Provider Name | Ms. Sydney Natosha Humphrey |
First Address | Atoka, OK 74525 |
Second Address | Atoka, OK 74525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2008 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4514 | LCSW (01) | OK |