Provider Demographics
NPI:1306007620
Name:HERRON, CHRISTOPHER L (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:L
Last Name:HERRON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2417
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-2417
Mailing Address - Country:US
Mailing Address - Phone:307-638-0300
Mailing Address - Fax:307-638-0394
Practice Address - Street 1:1950 BLUEGRASS CIR STE 150
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7362
Practice Address - Country:US
Practice Address - Phone:307-632-7771
Practice Address - Fax:307-632-9697
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY251103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical