Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | 39002060A | IN |
N | 103G00000X | Clinical Psychologist | 071008452 | IL |
N | 103TC0700X | Clinical Psychologist | 071008452 | IL |
Y | 103G00000X | Clinical Psychologist | 20042635A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042635A | IN |
NPI | 1013165075 |
---|---|
Provider Name | Jason Herr |
First Address | Merrillville, IN 46410-6385 |
Second Address | Merrillville, IN 46410-6451 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2008 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000616380 | ANTHEM (01) | IN |