Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) |
NPI | 1356683387 |
---|---|
Provider Name | Mr. Darryn K Herron I |
First Address | Tulsa, OK 74145-7905 |
Second Address | Tulsa, OK 74145-7905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2013 |
Last Update Date | 15/03/2013 |