Provider Demographics
NPI:1518524271
Name:HERRMANN, KARAH
Entity Type:Individual
Prefix:
First Name:KARAH
Middle Name:
Last Name:HERRMANN
Suffix:
Gender:F
Credentials:
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 151716
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78715-1716
Mailing Address - Country:US
Mailing Address - Phone:512-898-9044
Mailing Address - Fax:
Practice Address - Street 1:4407 PACK SADDLE PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1623
Practice Address - Country:US
Practice Address - Phone:512-784-7794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1457784605OtherABA CONNECT