Provider Demographics
NPI:1235784299
Name:HERRICK, CAROL ANN (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ANN
Last Name:HERRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1537 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1159
Mailing Address - Country:US
Mailing Address - Phone:303-324-1279
Mailing Address - Fax:
Practice Address - Street 1:1500 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1002
Practice Address - Country:US
Practice Address - Phone:720-810-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-07
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC0003388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
COLPC0003388OtherCOLORADO DEPARTMENT OF REGULATORY AGENCIES