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General NPI Number Information
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NPI Number | 1275015729
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Entity Type | Individual
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Provider Name | KATHRYN HERDER LPC
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Gender | Female
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Dates
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Enumeration Date | 08/31/2018
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 12225 N LOPEZ WELLS LN
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City | MARANA
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State | AZ
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Zip | 85658-0097
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Country | US
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Telephone | 970-880-1654
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Fax |
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Provider Business Mailing Address
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Address Line | 12225 N LOPEZ WELLS LN
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City | MARANA
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State | AZ
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Zip | 85658-0097
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC.0014869
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-20506
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License Number State | AZ
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