Provider Demographics
NPI:1174860712
Name:KERN, HERBERT III (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:KERN
Suffix:III
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SOUTH 20TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6837
Mailing Address - Country:US
Mailing Address - Phone:406-585-7300
Mailing Address - Fax:
Practice Address - Street 1:716 SOUTH 20TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-6837
Practice Address - Country:US
Practice Address - Phone:406-585-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4365101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT901188948OtherTAX ID