Provider Demographics
NPI:1497879019
Name:HERR, DOUGLAS (PSYD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:HERR
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 1:3401 W END AVE
Mailing Address - Street 2:SUITE 380
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1042
Mailing Address - Country:US
Mailing Address - Phone:503-583-3221
Mailing Address - Fax:
Practice Address - Street 1:3401 W END AVE
Practice Address - Street 2:SUITE 380
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1042
Practice Address - Country:US
Practice Address - Phone:503-583-3221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP2368103TC0700X
TN2368103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3585120Medicare ID - Type UnspecifiedMEDICARE NUMBER