Provider Demographics
NPI:1518709880
Name:DEN HERDER GROUP, LLC
Entity type:Organization
Organization Name:DEN HERDER GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:CHANCEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-671-0000
Mailing Address - Street 1:611 W 15TH ST APT B5
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9134
Mailing Address - Country:US
Mailing Address - Phone:918-671-0000
Mailing Address - Fax:
Practice Address - Street 1:611 W 15TH ST APT B5
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9134
Practice Address - Country:US
Practice Address - Phone:918-671-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty