Provider Demographics
NPI:1346819299
Name:HERMES, JOSEPH WALTER (MA LAC)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WALTER
Last Name:HERMES
Suffix:
Gender:M
Credentials:MA LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3238 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-7601
Mailing Address - Country:US
Mailing Address - Phone:651-303-1013
Mailing Address - Fax:
Practice Address - Street 1:811 MAIN CT
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-1851
Practice Address - Country:US
Practice Address - Phone:651-303-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)