Individual
MRS. JILLIAN MICHAEL HUMPHREY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
452 GOOSE POND RD, MORGANFIELD, KY 42437-5970
(270) 285-2265
Mailing address
452 GOOSE POND RD, MORGANFIELD, KY 42437-5970
(270) 285-2265
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
103K00000X
Behavior Analyst
Primary
272718
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100844780
—
KY
Enumeration date
10/25/2018
Last updated
10/02/2023
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