Provider Demographics
NPI:1912179896
Name:HERDER, CLARE LOUISE (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CLARE
Middle Name:LOUISE
Last Name:HERDER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27186 NEWPORT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-7386
Mailing Address - Country:US
Mailing Address - Phone:951-200-7505
Mailing Address - Fax:951-200-7505
Practice Address - Street 1:27186 NEWPORT RD STE 2
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92584-7385
Practice Address - Country:US
Practice Address - Phone:951-200-7505
Practice Address - Fax:951-200-7505
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45026106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist