Provider Demographics
NPI:1649166174
Name:HERREN, MAYA
Entity type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:HERREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 VOGEL RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-4020
Mailing Address - Country:US
Mailing Address - Phone:812-213-9000
Mailing Address - Fax:812-287-9449
Practice Address - Street 1:5901 VOGEL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-4020
Practice Address - Country:US
Practice Address - Phone:812-213-9000
Practice Address - Fax:812-287-9449
Is Sole Proprietor?:No
Enumeration Date:2025-06-12
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-25-424722106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician