Provider Demographics
NPI:1568038602
Name:HERRERA, ELENA VIRIDIANA
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VIRIDIANA
Last Name:HERRERA
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 1:2036 MCNITT ST
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-3407
Mailing Address - Country:US
Mailing Address - Phone:720-341-7445
Mailing Address - Fax:
Practice Address - Street 1:710 11TH AVE STE L46
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-3171
Practice Address - Country:US
Practice Address - Phone:970-888-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health