MEDICARE: KATHRYN HERDER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC.0014869	CO
2	101YM0800X	Mental Health Counselor	LPC-20506	AZ

General Provider Information

NPI Number	:	1275015729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN HERDER LPC

Provider Business Mailing Address
First Line	:	12225 N LOPEZ WELLS LN
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-0097
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12225 N LOPEZ WELLS LN
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-0097
Country	:	US
Telephone Number	:	970-880-1654
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2018
Last Update Date	:	05/13/2026

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