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General NPI Number Information
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NPI Number | 1972308393
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Entity Type | Individual
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Provider Name | LAVONNE RENEE HERNANDEZ
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Gender | Female
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 4825 ALLIANCE BLVD STE 150
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City | PLANO
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State | TX
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Zip | 75093-5577
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Country | US
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Telephone | 469-250-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 1516 BAFFIN BAY DR
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City | PLANO
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State | TX
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Zip | 75075-2204
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Country | US
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Telephone | 972-832-4223
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 95959
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License Number State | TX
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