Basic Information
| Provider Information | |||||||||
| NPI: | 1326199076 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HERRON | ||||||||
| FirstName: | PATRICK | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 285 BIELBY RD | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEBURG | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470251055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125371302 | ||||||||
| FaxNumber: | 8125375219 | ||||||||
| Practice Location | |||||||||
| Address1: | 460 NOWLIN AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | GREENDALE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 470252138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125377381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 35000815A | IN | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
ID Information
| ID | Type | State | Issuer | Description | 000000200312 | 01 | IN | BLUE SHIELD | OTHER |