Provider Demographics
NPI:1518731066
Name:HERRON, STEPHANIE DEE (AMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DEE
Last Name:HERRON
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:STEPHANIE HERRON
Mailing Address - Street 2:PO BOX 131
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-0131
Mailing Address - Country:US
Mailing Address - Phone:402-515-3268
Mailing Address - Fax:
Practice Address - Street 1:CLINIC FOR HEALING AND CHANGE
Practice Address - Street 2:3120 O STREET
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:209-406-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-14
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT140836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional