Provider Demographics
NPI:1104804103
Name:HERREN, CARLA M (PHD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:M
Last Name:HERREN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 W DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4627
Mailing Address - Country:US
Mailing Address - Phone:214-664-4100
Mailing Address - Fax:214-664-4101
Practice Address - Street 1:202 W DAVIS ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4627
Practice Address - Country:US
Practice Address - Phone:214-664-4100
Practice Address - Fax:214-664-4101
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25023103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099544101Medicaid
TX125938OtherNORTH STAR
TX099544101Medicaid