Provider Demographics
NPI:1639964885
Name:HERRON, KAMMERRIN JOELLE-CHEYANNE
Entity type:Individual
Prefix:
First Name:KAMMERRIN
Middle Name:JOELLE-CHEYANNE
Last Name:HERRON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15704 ORANGE AVE APT 250
Mailing Address - Street 2:
Mailing Address - City:PARAMOUNT
Mailing Address - State:CA
Mailing Address - Zip Code:90723-8518
Mailing Address - Country:US
Mailing Address - Phone:405-830-5269
Mailing Address - Fax:
Practice Address - Street 1:15704 ORANGE AVE APT 250
Practice Address - Street 2:
Practice Address - City:PARAMOUNT
Practice Address - State:CA
Practice Address - Zip Code:90723-8518
Practice Address - Country:US
Practice Address - Phone:405-830-5269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT154474106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist