MEDICARE: MR. JAMES ROBERT HERRON III AAC

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	101Y00000X	Counselor	CG60939765	WA

General Provider Information

NPI Number	:	1346709219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES ROBERT HERRON III AAC

Provider Business Mailing Address
First Line	:	1338 COMMERCE AVE STE 303
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3726
Country	:	US
Telephone Number	:	360-878-2219
Fax Number	:	844-554-3370

Provider Business Practice Location Address
First Line	:	1338 COMMERCE AVE STE 303
Second Line	:
City	:	LONGVIEW
State	:	WA
Zip	:	98632-3726
Country	:	US
Telephone Number	:	360-878-2219
Fax Number	:	844-554-3370

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

Provider Enumeration Date	:	03/19/2019
Last Update Date	:	03/19/2019

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