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General NPI Number Information
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NPI Number | 1013756667
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Entity Type | Individual
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Provider Name | PHILLIP LEE HERNDON BCBA
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Gender | Male
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Dates
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Enumeration Date | 05/23/2024
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 7120 SAMUEL MORSE DR STE 150
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City | COLUMBIA
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State | MD
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Zip | 21046-3420
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Country | US
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Telephone | 888-344-5977
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Fax |
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Provider Business Mailing Address
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Address Line | 7705 EARNSHAW DR
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City | BRANDYWINE
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State | MD
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Zip | 20613-7633
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Country | US
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Telephone | 626-260-6261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-72250
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License Number State | CO
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