Provider Demographics
NPI:1538713755
Name:HERRIMAN, KEITH JAMES (LLP)
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:JAMES
Last Name:HERRIMAN
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17105 W 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-2104
Mailing Address - Country:US
Mailing Address - Phone:502-593-6885
Mailing Address - Fax:248-557-6427
Practice Address - Street 1:17105 W 12 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-2104
Practice Address - Country:US
Practice Address - Phone:248-557-8390
Practice Address - Fax:248-557-6427
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361001627103TC1900X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling