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General NPI Number Information
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NPI Number | 1932249935
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Entity Type | Individual
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Provider Name | JACQUES P. HERTER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 03/12/2014
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Provider Practice Location Address
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Address Line | 535 W YELLOWSTONE HWY SUITE 202
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City | CASPER
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State | WY
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Zip | 82601-7507
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Country | US
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Telephone | 307-235-9004
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Fax | 866-467-2018
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Provider Business Mailing Address
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Address Line | 535 W YELLOWSTONE HWY STE 202
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City | CASPER
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State | WY
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Zip | 82601-7508
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Country | US
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Telephone | 307-235-9004
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Fax | 866-467-2018
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 93
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License Number State | WY
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