Provider Demographics
NPI:1467628008
Name:HERRON, ELIZABETH CAROTHERS (PHD, MFC)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CAROTHERS
Last Name:HERRON
Suffix:
Gender:F
Credentials:PHD, MFC
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 315
Mailing Address - Street 2:2630 S. EDISON ST.
Mailing Address - City:GRATON
Mailing Address - State:CA
Mailing Address - Zip Code:95444-0315
Mailing Address - Country:US
Mailing Address - Phone:707-522-9000
Mailing Address - Fax:
Practice Address - Street 1:2630 S EDISON ST
Practice Address - Street 2:
Practice Address - City:GRATON
Practice Address - State:CA
Practice Address - Zip Code:95444-9346
Practice Address - Country:US
Practice Address - Phone:707-522-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-04
Last Update Date:2008-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMC 2250106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist