Provider Demographics
NPI:1386831584
Name:HERRING, CARL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:
Last Name:HERRING
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 S WAVERLY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-3631
Mailing Address - Country:US
Mailing Address - Phone:517-321-5900
Mailing Address - Fax:517-321-5945
Practice Address - Street 1:302 S WAVERLY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-3631
Practice Address - Country:US
Practice Address - Phone:517-321-5900
Practice Address - Fax:517-321-5945
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006704103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical