MEDICARE: MERCEDES HERNANDEZ LAAC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	LAAC-15287	AZ

General Provider Information

NPI Number	:	1063365724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MERCEDES HERNANDEZ LAAC

Provider Business Mailing Address
First Line	:	2610 W ESTES WAY
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85041-9535
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3639 W LINCOLN ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85009-5516
Country	:	US
Telephone Number	:	602-233-9747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2026
Last Update Date	:	02/20/2026

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