Individual
DR. JOHN THOMAS HEROLDT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.D., HSPP
Contact information
Practice address
717 MICHIGAN AVE, LA PORTE, IN 46350-3371
(219) 874-2518
(219) 756-8945
Mailing address
1652 TIPPECANOE CT, VALPARAISO, IN 46385-6142
(219) 874-2518
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040372A
IN
Other
Enumeration date
07/19/2006
Last updated
12/14/2007
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