Healthcare Provider Details

I. General information

NPI: 1821548892
Provider Name (Legal Business Name): HERLINDA A HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 THOMPSON DR
KERRVILLE TX
78028-5144
US

IV. Provider business mailing address

PO BOX 2191
BOERNE TX
78006-3602
US

V. Phone/Fax

Practice location:
  • Phone: 830-257-6553
  • Fax:
Mailing address:
  • Phone: 210-723-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number69568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: