Provider Demographics
NPI:1457862344
Name:HERNANDEZ, MARI BEA (LPC)
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:BEA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARI
Other - Middle Name:BEA
Other - Last Name:HOAGLUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:4633 WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53144-4220
Mailing Address - Country:US
Mailing Address - Phone:262-652-7222
Mailing Address - Fax:262-652-1732
Practice Address - Street 1:4633 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53144-4220
Practice Address - Country:US
Practice Address - Phone:262-652-7222
Practice Address - Fax:262-652-1732
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6650-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty