Provider Demographics
NPI:1831638857
Name:HERRERA, CHRIS
Entity Type:Individual
Prefix:MR
First Name:CHRIS
Middle Name:
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23332 HAWTHORNE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4457
Mailing Address - Country:US
Mailing Address - Phone:213-302-8259
Mailing Address - Fax:
Practice Address - Street 1:23332 HAWTHORNE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4457
Practice Address - Country:US
Practice Address - Phone:213-302-8259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT97865101YM0800X
CA130481106H00000X
CALMFT130481106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health