Healthcare Provider Details

I. General information

NPI: 1912040502
Provider Name (Legal Business Name): KIMBERLY JEAN HERKERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 12/02/2023
Certification Date: 12/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 WILSON ST
EUREKA CA
95503-4829
US

IV. Provider business mailing address

843 O ST
FORTUNA CA
95540-1932
US

V. Phone/Fax

Practice location:
  • Phone: 707-498-5201
  • Fax:
Mailing address:
  • Phone: 707-498-5201
  • Fax: 707-623-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number48906
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number77121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: