Provider Demographics
NPI:1487412078
Name:HERD, KAYSHA SYDELLE (MA, LPC)
Entity type:Individual
Prefix:MISS
First Name:KAYSHA
Middle Name:SYDELLE
Last Name:HERD
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-7561
Mailing Address - Country:US
Mailing Address - Phone:512-461-0865
Mailing Address - Fax:
Practice Address - Street 1:208 VALLEY DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-7561
Practice Address - Country:US
Practice Address - Phone:512-461-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82835101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional