Provider Demographics
NPI:1013557198
Name:HERNANDEZ, LIZETH
Entity Type:Individual
Prefix:
First Name:LIZETH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6821 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-1601
Mailing Address - Country:US
Mailing Address - Phone:832-403-1409
Mailing Address - Fax:
Practice Address - Street 1:350 N SAM HOUSTON PKWY E STE 238
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77060-3320
Practice Address - Country:US
Practice Address - Phone:832-761-3176
Practice Address - Fax:832-761-3179
Is Sole Proprietor?:No
Enumeration Date:2020-01-07
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician