Provider Demographics
NPI:1871287417
Name:HUMPHRIES, KAITLYN LOUISE (MSW)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:LOUISE
Last Name:HUMPHRIES
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4739
Mailing Address - Country:US
Mailing Address - Phone:409-202-3107
Mailing Address - Fax:
Practice Address - Street 1:1050 S 11TH ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4739
Practice Address - Country:US
Practice Address - Phone:409-202-3107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health