Individual
JAMIE HERRERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LISAC
Contact information
Practice address
2311 W ROYAL PALM RD, PHOENIX, AZ 85021-4916
(602) 353-2340
Mailing address
202 E EARLL DR STE 200, PHOENIX, AZ 85012-2647
(602) 808-2800
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LISAC10664
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032042
—
AZ
Enumeration date
06/24/2015
Last updated
02/26/2019
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