Organization
JACK L. HUMPHRIES, LISW, LTD.
Active
Organization
JACK L. HUMPHRIES, LISW, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JACK L. HUMPHRIES LISW (PRESIDENT)
(505) 620-5225
Entity
Organization
Contact information
Practice address
8800 PALOMAR AVE NE, ALBUQUERQUE, NM 87109-7205
(505) 620-5225
(505) 798-1743
Mailing address
PO BOX 16387, ALBUQUERQUE, NM 87191-6387
(505) 620-5225
(505) 798-1743
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
I-3613
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
24500721
—
NM
05
—
37982788
—
NM
05
—
D-4525
—
NM
05
—
NM60084
—
NM
Enumeration date
12/30/2006
Last updated
08/22/2020
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