Humphries, David Madison

Humphries, David Madison is an individual health care provider with primary practice located at 355 Nw Division St , Gresham OR 97030-5523. He recently has only one registered license in Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), which is considered as his primary health care specialty. Humphries, David Madison can be contacted via phone (971) 225-6695.

Contact Information

Primary practice address
355 Nw Division St Gresham OR 97030-5523
Phone: (971) 225-6695
Fax: (503) 231-1654
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 17-CRM-II-011 Oregon
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 14-07-06 Oregon

Profile Details

NPI number 1184054710
LBN Legal business name Humphries, David Madison
Credentials CADC I/CRM II
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 18th, 2013
Last updated Apr 15th, 2025 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184054710 NPPES
Oregon MEDICAID 500699779
Oregon MEDICAID 500730604

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