Basic Information
| Provider Information | |||||||||
| NPI: | 1013165075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HERR | ||||||||
| FirstName: | JASON | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMHC, CP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8400 LOUISIANA ST | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106385 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197571928 | ||||||||
| FaxNumber: | 2197571950 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 E 84TH PL | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197942000 | ||||||||
| FaxNumber: | 2197942010 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 11/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 39002060A | IN | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 103TC0700X | 20042635A | IN | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TC0700X | 071008452 | IL | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 000000616380 | 01 | IN | ANTHEM | OTHER |