Provider Demographics
NPI:1720533805
Name:HERRERA, EDWARD ADLEN
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:ADLEN
Last Name:HERRERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 NTH 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98407
Mailing Address - Country:US
Mailing Address - Phone:253-312-8909
Mailing Address - Fax:
Practice Address - Street 1:3704 NTH 35TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98407
Practice Address - Country:US
Practice Address - Phone:253-312-8909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-18
Last Update Date:2018-01-24
Deactivation Date:2017-12-30
Deactivation Code:
Reactivation Date:2018-01-24
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst