Provider Demographics
NPI:1013349083
Name:HERRON, PETE (LMFT)
Entity Type:Individual
Prefix:MR
First Name:PETE
Middle Name:
Last Name:HERRON
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 13TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2456
Mailing Address - Country:US
Mailing Address - Phone:209-380-3187
Mailing Address - Fax:209-846-0913
Practice Address - Street 1:615 13TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2456
Practice Address - Country:US
Practice Address - Phone:209-380-3187
Practice Address - Fax:209-846-0913
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist