Healthcare Provider Details

I. General information

NPI: 1053875195
Provider Name (Legal Business Name): YARED E HERNANDEZ LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1264 RODEO RD
SANTA FE NM
87505-6816
US

IV. Provider business mailing address

1964 MURCHISON DR APT 2B
EL PASO TX
79902-3037
US

V. Phone/Fax

Practice location:
  • Phone: 505-500-4489
  • Fax:
Mailing address:
  • Phone: 505-500-4489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCMH0201471
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: