MEDICARE: THERESA HERNANDEZ LPC

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	101YP2500X	Professional Counselor	LPC.0015344	CO

General Provider Information

NPI Number	:	1144832890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA HERNANDEZ LPC

Provider Business Mailing Address
First Line	:	7561 SUN PRAIRIE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9567
Country	:	US
Telephone Number	:	210-275-5015
Fax Number	:

Provider Business Practice Location Address
First Line	:	7561 SUN PRAIRIE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80925-9567
Country	:	US
Telephone Number	:	210-275-5015
Fax Number	:

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

Provider Enumeration Date	:	08/22/2020
Last Update Date	:	08/22/2020

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