MEDICARE: GARY J. HERR 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	101YP2500X	Professional Counselor	LPC 14126	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1976488	OTHER	TX	FIRST HEALTH
2	3470LC	OTHER	TX	BC/BS

General Provider Information

NPI Number	:	1891703385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY J. HERR LPC

Provider Business Mailing Address
First Line	:	214 N CADDO ST
Second Line	:
City	:	CLEBURNE
State	:	TX
Zip	:	76031-4904
Country	:	US
Telephone Number	:	817-558-2988
Fax Number	:	817-558-3157

Provider Business Practice Location Address
First Line	:	1555 MERRIMAC CIR
Second Line	:	SUITE 104
City	:	FORT WORTH
State	:	TX
Zip	:	76107-6530
Country	:	US
Telephone Number	:	817-551-2973
Fax Number	:	817-293-0382

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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Directions to “ GARY J. HERR LPC” Practice Location

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