Provider Demographics
NPI:1174505721
Name:HERTER, AMY LERAE (MFC)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:LERAE
Last Name:HERTER
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:LERAE
Other - Last Name:MCROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:954 W FOOTHILL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3782
Mailing Address - Country:US
Mailing Address - Phone:909-946-4222
Mailing Address - Fax:909-946-8243
Practice Address - Street 1:954 W FOOTHILL BLVD STE A
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3782
Practice Address - Country:US
Practice Address - Phone:909-946-4222
Practice Address - Fax:909-946-8243
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39199106H00000X
CA39199106H00000X
CAMFC39199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist