Provider Demographics
NPI:1669024238
Name:HERRON, KRISTIAN (T-CADC)
Entity type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:T-CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 N MILES ST APT G8
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7950
Mailing Address - Country:US
Mailing Address - Phone:270-234-3712
Mailing Address - Fax:
Practice Address - Street 1:2410 RING RD STE 500
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7991
Practice Address - Country:US
Practice Address - Phone:270-982-1280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY255408101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor