Provider Demographics
NPI:1710351929
Name:HERSTEIN, MINDY ELYSE
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:ELYSE
Last Name:HERSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MINDY
Other - Middle Name:ELYSE
Other - Last Name:HERSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1001 E LOOKOUT DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-4144
Mailing Address - Country:US
Mailing Address - Phone:972-766-0464
Mailing Address - Fax:
Practice Address - Street 1:1001 E LOOKOUT DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-4144
Practice Address - Country:US
Practice Address - Phone:972-766-0464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73090101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional