Provider Demographics
NPI:1487933909
Name:HERRIN, TAYLOR CAMERON (LMFT)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:CAMERON
Last Name:HERRIN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S SAM GATES RD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-4773
Mailing Address - Country:US
Mailing Address - Phone:801-475-0402
Mailing Address - Fax:801-475-7464
Practice Address - Street 1:5149 S 1500 W
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:UT
Practice Address - Zip Code:84405-3926
Practice Address - Country:US
Practice Address - Phone:801-475-0402
Practice Address - Fax:801-475-7464
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6784539-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist