Healthcare Provider Details

I. General information

NPI: 1194085464
Provider Name (Legal Business Name): CYNTHIA ALISIA HERRON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16538 N MAY AVE
EDMOND OK
73012-9007
US

IV. Provider business mailing address

27777 INKSTER RD STE 100
FARMINGTON HILLS MI
48334-5312
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-9208
  • Fax: 317-520-8200
Mailing address:
  • Phone: 248-299-0030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401000983
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-39700
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: