Provider Demographics
NPI:1659719763
Name:HERRANEN, MARK (LPC- INTERN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HERRANEN
Suffix:
Gender:M
Credentials:LPC- INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4314 YOAKUM BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-5864
Mailing Address - Country:US
Mailing Address - Phone:713-850-0049
Mailing Address - Fax:713-627-7302
Practice Address - Street 1:4314 YOAKUM BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-5864
Practice Address - Country:US
Practice Address - Phone:713-850-0049
Practice Address - Fax:713-627-7302
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70318101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional