Provider Demographics
NPI:1902932320
Name:HERRING, JASON RYAN (LCSW)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:RYAN
Last Name:HERRING
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:942 SEARCY WAY
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7168
Mailing Address - Country:US
Mailing Address - Phone:270-781-8112
Mailing Address - Fax:270-781-8114
Practice Address - Street 1:942 SEARCY WAY
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103
Practice Address - Country:US
Practice Address - Phone:270-781-8112
Practice Address - Fax:270-781-8114
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33611041C0700X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30604011Medicaid