Provider Demographics
NPI:1639216443
Name:HERIZA, JOHN PATRICK (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PATRICK
Last Name:HERIZA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13997 CALLEY FISHER LN
Mailing Address - Street 2:
Mailing Address - City:HAINES
Mailing Address - State:OR
Mailing Address - Zip Code:97833-6368
Mailing Address - Country:US
Mailing Address - Phone:541-523-9539
Mailing Address - Fax:541-523-9539
Practice Address - Street 1:1948 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-3451
Practice Address - Country:US
Practice Address - Phone:541-523-9539
Practice Address - Fax:541-523-9539
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL35041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical