Provider Demographics
NPI:1245740034
Name:HERNANDEZ, STEPHEN NICHOLAS (BCBA)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NICHOLAS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 BUCKHORN
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-9537
Mailing Address - Country:US
Mailing Address - Phone:972-795-0576
Mailing Address - Fax:
Practice Address - Street 1:103 BUCKHORN
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-9537
Practice Address - Country:US
Practice Address - Phone:972-795-0576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-27718103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst