MEDICARE: LARA HERNANDEZ THERAPY, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1013474378
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LARA HERNANDEZ THERAPY, PLLC

Provider Business Mailing Address
First Line	:	3810 MEDICAL PKWY STE 255
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-4014
Country	:	US
Telephone Number	:	512-992-6083
Fax Number	:

Provider Business Practice Location Address
First Line	:	3810 MEDICAL PKWY STE 255
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-4014
Country	:	US
Telephone Number	:	512-992-6083
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL COUNSELOR
Name	:	LARA A HERNANDEZ
Credential	:	LPC
Telephone Number	:	512-992-6083

Provider Enumeration Date	:	02/22/2019
Last Update Date	:	08/22/2019

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