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NPI Code Detail

MEDICARE: LAUREN BAILEY HERD

MEDICARE:   LAUREN BAILEY HERD
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
1101YP2500XProfessional Counselor
2101Y00000XCounselor

General Provider Information

NPI Number : 1639782824
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN BAILEY HERD
Provider Business Mailing Address
First Line : 45 E MONTEREY WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 45 E MONTEREY WAY
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-2753
Country : US
Telephone Number : 480-641-1165
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 08/26/2020

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Directions to “ LAUREN BAILEY HERD ” Practice Location

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