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General NPI Number Information
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NPI Number | 1922248467
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Entity Type | Individual
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Provider Name | CULLEN F HEROUT LPC
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Gender | Male
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 100 CHURCH ST
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City | LEWISBURG
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State | WV
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Zip | 24901-1304
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Country | US
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Telephone | 304-645-3319
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Fax | 304-645-6532
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Provider Business Mailing Address
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Address Line | 1305 WEBSTER RD
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City | SUMMERSVILLE
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State | WV
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Zip | 26651-1125
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Country | US
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Telephone | 304-872-6503
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Fax | 304-872-5415
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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 | 18
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License Number State | WV
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