Healthcare Provider Details

I. General information

NPI: 1538642871
Provider Name (Legal Business Name): MONTINA HERBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 09/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 W WASHINGTON ST
SHELBYVILLE IN
46176-1245
US

IV. Provider business mailing address

820 W 8TH ST
RUSHVILLE IN
46173-1030
US

V. Phone/Fax

Practice location:
  • Phone: 317-289-2270
  • Fax:
Mailing address:
  • Phone: 765-561-6280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: