Provider Demographics
NPI:1124389648
Name:HERDT, CANDACE RAE (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:RAE
Last Name:HERDT
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16193 E 18TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80011-4801
Mailing Address - Country:US
Mailing Address - Phone:402-366-5629
Mailing Address - Fax:720-859-7703
Practice Address - Street 1:9100 E LOWRY BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6935
Practice Address - Country:US
Practice Address - Phone:303-780-9191
Practice Address - Fax:303-780-9192
Is Sole Proprietor?:No
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC6520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional