Provider Demographics
NPI:1093821365
Name:HERNDON, VIVIAN (LIMHP)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:
Last Name:HERNDON
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11330 Q ST STE 218
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3679
Mailing Address - Country:US
Mailing Address - Phone:402-659-4742
Mailing Address - Fax:531-466-4960
Practice Address - Street 1:11330 Q ST STE 218
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3679
Practice Address - Country:US
Practice Address - Phone:402-659-4742
Practice Address - Fax:531-466-4960
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE410101YM0800X
NE298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026194300Medicaid