Provider Demographics
NPI:1114649704
Name:HERRERA, IVON (LPC, NCC)
Entity type:Individual
Prefix:
First Name:IVON
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 MCKINNEY AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2059
Mailing Address - Country:US
Mailing Address - Phone:972-695-3421
Mailing Address - Fax:
Practice Address - Street 1:4054 MCKINNEY AVE STE 300
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2059
Practice Address - Country:US
Practice Address - Phone:972-695-3421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81626101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health