Provider Demographics
NPI:1629877881
Name:HUMPHREYS, JEFFREY EDGAR (LMHC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EDGAR
Last Name:HUMPHREYS
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 W SUNNYSIDE WAY APT 221
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1495
Mailing Address - Country:US
Mailing Address - Phone:631-599-3113
Mailing Address - Fax:
Practice Address - Street 1:120 DEFREEST DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-7608
Practice Address - Country:US
Practice Address - Phone:518-417-2262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health