Basic Information
Provider Information | |||||||||
NPI: | 1982164570 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | HERNANDEZ COUNSELING & ASSOCIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 12440 FIRESTONE BLVD STE 201 | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | CA | ||||||||
PostalCode: | 906509323 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5624500620 | ||||||||
FaxNumber: | 4243786329 | ||||||||
Practice Location | |||||||||
Address1: | 12440 FIRESTONE BLVD STE 201 | ||||||||
Address2: |   | ||||||||
City: | NORWALK | ||||||||
State: | CA | ||||||||
PostalCode: | 906509323 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5624500620 | ||||||||
FaxNumber: | 4243786329 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2019 | ||||||||
LastUpdateDate: | 03/21/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HERNANDEZ | ||||||||
AuthorizedOfficialFirstName: | BARBARA | ||||||||
AuthorizedOfficialMiddleName: | ANN | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDEINT/OWNER | ||||||||
AuthorizedOfficialTelephone: | 5624500620 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | LMFT, LPCC, PSY.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.