Provider Demographics
NPI:1851176291
Name:HERRERA, CANDICE RAVEN (MA, LPC-A)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:RAVEN
Last Name:HERRERA
Suffix:
Gender:F
Credentials:MA, LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 MILL OAK LN
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-8504
Mailing Address - Country:US
Mailing Address - Phone:830-391-6789
Mailing Address - Fax:
Practice Address - Street 1:480 MILL OAK LN
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-8504
Practice Address - Country:US
Practice Address - Phone:830-391-6789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92643101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional