MEDICARE: JOHANNA HERRON LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1528460144
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHANNA HERRON LMFT

Provider Business Mailing Address
First Line	:	1100 LINCOLN AVE
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94558-4900
Country	:	US
Telephone Number	:	170-722-9381
Fax Number	:	170-725-5371

Provider Business Practice Location Address
First Line	:	2245 CHALLENGER WAY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95407-5418
Country	:	US
Telephone Number	:	707-565-4980
Fax Number	:	707-565-4865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	05/13/2021

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