Provider Demographics
NPI:1619673688
Name:HERNANDEZ, SARAH SULLIVAN (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:SULLIVAN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14587 COUNTY ROAD 73
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:76384-8203
Mailing Address - Country:US
Mailing Address - Phone:940-357-0241
Mailing Address - Fax:
Practice Address - Street 1:1900 PEASE ST
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4608
Practice Address - Country:US
Practice Address - Phone:940-357-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional