MEDICARE: MICHAEL HERRON

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

General Provider Information

NPI Number	:	1922421478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL HERRON

Provider Business Mailing Address
First Line	:	7545 BURNETTE ST
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48210-3304
Country	:	US
Telephone Number	:	702-445-6350
Fax Number	:	702-445-6354

Provider Business Practice Location Address
First Line	:	2480 N DECATUR BLVD STE 125
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89108-2985
Country	:	US
Telephone Number	:	702-445-6350
Fax Number	:	702-445-6354

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

Provider Enumeration Date	:	02/03/2014
Last Update Date	:	02/03/2014

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Directions to “ MICHAEL HERRON ” Practice Location

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