Provider Demographics
NPI:1376433813
Name:FERNANDEZ, ANTONIO JR (LMHC-A)
Entity type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:
Last Name:FERNANDEZ
Suffix:JR
Gender:M
Credentials:LMHC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 NORTH 18TH STREET
Mailing Address - Street 2:HOWARTH CENTER, SUITE 101
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904
Mailing Address - Country:US
Mailing Address - Phone:786-537-9308
Mailing Address - Fax:
Practice Address - Street 1:615 NORTH 18TH STREET
Practice Address - Street 2:HOWARTH CENTER, SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904
Practice Address - Country:US
Practice Address - Phone:786-537-9308
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88002882A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health