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Individual

TRACY HUMPHREY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
CIT

Contact information

Practice address
400 LAKE FRONT DR, RUSSELLVILLE, AR 72802-2206
(479) 968-7086
(479) 968-4331
Mailing address
PO BOX 1463, RUSSELLVILLE, AR 72811-1463
(479) 968-7086
(479) 968-7225

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary

Other

Enumeration date
06/12/2015
Last updated
06/12/2015
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