Provider Demographics
NPI:1417412289
Name:HERNANDEZ, JEANNETTE RENEE (LMFT)
Entity Type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:RENEE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 COLDWATER CANYON AVE STE 1B
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91605-5164
Mailing Address - Country:US
Mailing Address - Phone:818-301-6370
Mailing Address - Fax:
Practice Address - Street 1:6801 COLDWATER CANYON AVE STE 1B
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605-5164
Practice Address - Country:US
Practice Address - Phone:818-301-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health