Elliott Humphries

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

A20914 Issued in NC

Practice address

618 N Howe St
Southport, NC 28461-3426

Phone

(336) 346-4386

Fax

(743) 208-6507

NPI assigned

Nov 21, 2024

Last updated

Dec 20, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Just Be Counseling and Wellness, PLLC

  • Group Psychotherapy Psychologist
  • Burlington, NC
  • NPI 1134944515
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1732147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734652800000",
    "number": "1972328219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2207 DELANEY DR STE 206",
            "city": "BURLINGTON",
            "state": "NC",
            "postal_code": "272155263",
            "telephone_number": "336-346-4386",
            "fax_number": "743-208-6507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 N HOWE ST",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284613426",
            "telephone_number": "336-346-4386",
            "fax_number": "743-208-6507"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2207 Delaney Dr Ste 206",
            "address_purpose": "LOCATION",
            "city": "Burlington",
            "state": "NC",
            "postal_code": "272155263",
            "country_code": "US",
            "telephone_number": "336-346-4386",
            "fax_number": "743-208-6507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUMPHRIES",
        "first_name": "ELLIOTT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-11-21",
        "last_updated": "2024-12-20",
        "certification_date": "2024-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "A20914",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Holden, ACNP-BC
• George Thomas Holland, MD
• Ginny Hopkins, COTA/L
• Howard Eye Associates, OD PA
• John Michael Howard, OD
• Diana Melisa Idelson, LCSW
• Intracoastal Executive Wellness
• Charlene D Irvin
• John D Irvin, MD
• Jo Revelle Murray Isenhour, MED CCC-SLP

• Mental Health Counselor in Southport, NC
• Providers in Southport, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.