Individual
MR. JUSTIN I. HERSOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
17250 WILSON RIVER HWY, TILLAMOOK, OR 97141-9145
(832) 326-8552
(503) 842-5035
Mailing address
17250 WILSON RIVER HWY, TILLAMOOK, OR 97141-9145
(832) 326-8552
(503) 842-5035
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
55202
TX
1041C0700X
Clinical Social Worker
55202
TX
1041C0700X
Clinical Social Worker
Primary
6051
OR
Other
Enumeration date
04/18/2013
Last updated
07/12/2022
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