Provider Demographics
NPI:1083941553
Name:HERNANDEZ, JUSTIN (LPCC-S)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LPCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8406 ANTLERS TRL
Mailing Address - Street 2:
Mailing Address - City:NORTH RIDGEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44039-6403
Mailing Address - Country:US
Mailing Address - Phone:330-261-2027
Mailing Address - Fax:
Practice Address - Street 1:6200 ROCKSIDE WOODS BLVD N
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2333
Practice Address - Country:US
Practice Address - Phone:216-312-1368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC0800099101YP2500X
OHE.0800099-SUPV101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional