Provider Demographics
NPI:1346709219
Name:HERRON, JAMES ROBERT III (AAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ROBERT
Last Name:HERRON
Suffix:III
Gender:M
Credentials:AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1338 COMMERCE AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3726
Mailing Address - Country:US
Mailing Address - Phone:360-878-2219
Mailing Address - Fax:844-554-3370
Practice Address - Street 1:1338 COMMERCE AVE STE 303
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3726
Practice Address - Country:US
Practice Address - Phone:360-878-2219
Practice Address - Fax:844-554-3370
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60939765101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor