MEDICARE: EDGAR ENRIQUE HERRERA

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-04214-T	KS

General Provider Information

NPI Number	:	1669187274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDGAR ENRIQUE HERRERA

Provider Business Mailing Address
First Line	:	239 W PANCAKE BLVD STE 106
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-4007
Country	:	US
Telephone Number	:	620-621-9543
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N KANSAS AVE
Second Line	:
City	:	LIBERAL
State	:	KS
Zip	:	67901-3304
Country	:	US
Telephone Number	:	620-604-5111
Fax Number	:

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

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	01/18/2023

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Directions to “ EDGAR ENRIQUE HERRERA ” Practice Location

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