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General NPI Number Information
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NPI Number | 1275046682
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Entity Type | Individual
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Provider Name | MICHELLE S HERTTER LCDC
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Gender | Female
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 801 ROAD TO SIX FLAGS W
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City | ARLINGTON
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State | TX
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Zip | 76012-2616
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Country | US
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Telephone | 817-795-3030
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Fax | 817-795-3099
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Provider Business Mailing Address
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Address Line | 3001A W 5TH ST
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City | FORT WORTH
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State | TX
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Zip | 76107-2206
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Country | US
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Telephone | 817-338-0311
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Fax | 817-332-9075
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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