Provider Demographics
NPI:1568595866
Name:HERROD, FAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:FAY
Middle Name:
Last Name:HERROD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627
Mailing Address - Country:US
Mailing Address - Phone:724-539-7411
Mailing Address - Fax:
Practice Address - Street 1:110 FRANKLIN ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901
Practice Address - Country:US
Practice Address - Phone:724-535-8531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002501LPC101Y00000X
PA60214101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor