MEDICARE: KIMBERLY JANE HERNANDEZ LPCC, LAC

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	0002938	CO
2	101YP2500X	Professional Counselor	0022899	CO

General Provider Information

NPI Number	:	1134922750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JANE HERNANDEZ LPCC, LAC

Provider Business Mailing Address
First Line	:	6654 TIGER PAW
Second Line	:
City	:	LONE TREE
State	:	CO
Zip	:	80124-9563
Country	:	US
Telephone Number	:	970-281-5303
Fax Number	:

Provider Business Practice Location Address
First Line	:	1745 SHEA CENTER DR # 455
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80129-1537
Country	:	US
Telephone Number	:	970-281-5303
Fax Number	:

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

Provider Enumeration Date	:	03/29/2025
Last Update Date	:	03/28/2026

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