Individual
ROBERT HUMPHRIES JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1201 S MAIN ST, SUITE 100, NORTH CANTON, OH 44720-4283
(330) 244-8782
(330) 244-8795
Mailing address
1201 SOUTH MAIN ST., SUITE 100, NORTH CANTON, OH 44720
(330) 244-8782
(330) 244-8795
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5492
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000130016
ANTHEM
OH
01
—
083656000
MAGELLAN
OH
01
—
191242
MHN
OH
05
—
2106563
—
OH
01
—
341302914034
CARESOURCE
OH
Enumeration date
12/08/2006
Last updated
06/26/2010
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