Provider Demographics
NPI:1841278629
Name:HERBS, DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:HERBS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4012 SO RAINBOW BLVD
Mailing Address - Street 2:K484
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-2010
Mailing Address - Country:US
Mailing Address - Phone:702-212-3008
Mailing Address - Fax:
Practice Address - Street 1:1771 E FLAMINGO RD
Practice Address - Street 2:SUITE 112 B
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119
Practice Address - Country:US
Practice Address - Phone:701-641-2422
Practice Address - Fax:702-893-9655
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0351103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V32068Medicare ID - Type Unspecified