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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