Provider Demographics
NPI:1689829202
Name:HERRICK, CHRISTEN G (PHD)
Entity type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:G
Last Name:HERRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SLATE DR STE 4
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6181
Mailing Address - Country:US
Mailing Address - Phone:701-877-1806
Mailing Address - Fax:701-222-0331
Practice Address - Street 1:201 SLATE DR STE 4
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6181
Practice Address - Country:US
Practice Address - Phone:701-877-1806
Practice Address - Fax:701-222-0331
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND420103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDP00767214OtherRR MEDICARE
ND420OtherLICENSE
ND10033Medicaid
ND10033Medicaid