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General NPI Number Information
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NPI Number | 1619662491
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Entity Type | Individual
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Provider Name | CAROLYN HERRERA M.A.
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Gender | Female
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Dates
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Enumeration Date | 04/07/2023
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Last Update Date | 08/11/2023
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Provider Practice Location Address
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Address Line | 4301 WEST MARKHAM, SLOT 589
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City | LITTLE ROCK
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State | AR
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Zip | 72205
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Country | US
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Telephone | 501-526-8148
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Fax |
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Provider Business Mailing Address
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Address Line | 14409 MEADOW CT
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City | LEAWOOD
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State | KS
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Zip | 66224-3963
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Country | US
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Telephone | 816-809-9294
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 202291
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License Number State | AR
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