Individual
LISA HERTERICH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, PMHNP-BC
Contact information
Practice address
5100 FOUNTAIN LN, LONGVIEW, TX 75604-9462
(903) 235-8222
Mailing address
5100 FOUNTAIN LN, LONGVIEW, TX 75604-9462
(903) 235-8222
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
532689
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
1101552
TX
Other
Enumeration date
08/16/2022
Last updated
01/03/2023
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