Basic Information
| Provider Information | |||||||||
| NPI: | 1639377427 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUMBLE | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 496 SOUTHLAND DR | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405031827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592882392 | ||||||||
| FaxNumber: | 8597213918 | ||||||||
| Practice Location | |||||||||
| Address1: | 144 LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405021514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8595760002 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2007 | ||||||||
| LastUpdateDate: | 05/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | KY-544 | KY | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 7100282640 | 05 | KY | MEDICAID |