Provider Demographics
NPI:1225394836
Name:CATHERINE L. HERZOG, PH.D., PLLC
Entity Type:Organization
Organization Name:CATHERINE L. HERZOG, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:LYDIA
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:248-701-1093
Mailing Address - Street 1:1370 N OAKLAND BLVD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48327-4525
Mailing Address - Country:US
Mailing Address - Phone:248-701-1093
Mailing Address - Fax:248-886-1372
Practice Address - Street 1:1370 N OAKLAND BLVD
Practice Address - Street 2:SUITE 100A
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48327-4525
Practice Address - Country:US
Practice Address - Phone:248-701-1093
Practice Address - Fax:248-886-1372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008327261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)