Provider Demographics
NPI:1710308903
Name:HERRIFORD, WHAYNE (LPCA)
Entity Type:Individual
Prefix:
First Name:WHAYNE
Middle Name:
Last Name:HERRIFORD
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 DIVISION ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:KY
Mailing Address - Zip Code:41073-1375
Mailing Address - Country:US
Mailing Address - Phone:859-951-6162
Mailing Address - Fax:
Practice Address - Street 1:335 DIVISION ST APT 2
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:KY
Practice Address - Zip Code:41073-1375
Practice Address - Country:US
Practice Address - Phone:859-951-6162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-14
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID