Provider Demographics
NPI:1497482830
Name:HERNDON, ABBY MARIE (MS)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:MARIE
Last Name:HERNDON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6846 S CANTON AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3430
Mailing Address - Country:US
Mailing Address - Phone:918-745-0095
Mailing Address - Fax:918-745-0190
Practice Address - Street 1:6846 S CANTON AVE STE 600
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-3430
Practice Address - Country:US
Practice Address - Phone:918-745-0095
Practice Address - Fax:918-745-0190
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCANDIDATE101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor