Healthcare Provider Details

I. General information

NPI: 1922581396
Provider Name (Legal Business Name): TAMARA ANN HERNANDEZ CPC-I, MSCRMHC, BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMARA ANN MULLIS CPC-I, MSCRMHC, ASDI

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/28/2024
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 JUNIPER RIDGE AVE
HENDERSON NV
89015-6902
US

IV. Provider business mailing address

3960 E PATRICK LN STE 202
LAS VEGAS NV
89120-4902
US

V. Phone/Fax

Practice location:
  • Phone: 702-809-7748
  • Fax:
Mailing address:
  • Phone: 702-810-9927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: