Provider Demographics
NPI:1629847769
Name:HERNDON, ENYLA MARIE
Entity Type:Individual
Prefix:
First Name:ENYLA
Middle Name:MARIE
Last Name:HERNDON
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 1:17518 HEATH GROVE LN
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-8030
Mailing Address - Country:US
Mailing Address - Phone:346-779-6580
Mailing Address - Fax:
Practice Address - Street 1:17518 HEATH GROVE LN
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-8030
Practice Address - Country:US
Practice Address - Phone:346-779-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician