Provider Demographics
NPI:1891703385
Name:HERR, GARY J (LPC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:J
Last Name:HERR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:214 N CADDO ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-4904
Mailing Address - Country:US
Mailing Address - Phone:817-558-2988
Mailing Address - Fax:817-558-3157
Practice Address - Street 1:1555 MERRIMAC CIR
Practice Address - Street 2:SUITE 104
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6530
Practice Address - Country:US
Practice Address - Phone:817-551-2973
Practice Address - Fax:817-293-0382
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 14126101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1976488OtherFIRST HEALTH
TX3470LCOtherBC/BS