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General NPI Number Information
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NPI Number | 1821203969
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Entity Type | Organization
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Legal Business Name | HERLIHY CLINIC P.C.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 1695 E SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6424
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Country | US
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Telephone | 817-442-0200
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Fax | 817-442-0204
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Provider Business Mailing Address
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Address Line | 1695 E SOUTHLAKE BLVD
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City | SOUTHLAKE
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State | TX
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Zip | 76092-6424
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Country | US
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Telephone | 817-442-0200
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Fax | 817-442-0204
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES EDWARD HERLIHY, JR.
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Credential | M.D.
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Telephone | 817-442-0200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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