=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598869588
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN HERINGTON, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2006
-----------------------------------------------------
Last Update Date | 12/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2490 N WATER ST SUITE 1
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62526-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-233-1327
-----------------------------------------------------
Fax | 217-233-1328
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 30
-----------------------------------------------------
City | WARRENSBURG
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62573-0030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-233-1327
-----------------------------------------------------
Fax | 217-233-1328
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. JOHN RICHARD HERINGTON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 217-233-1327
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149-1721
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------