Provider Demographics
NPI:1679242689
Name:HERNANDEZ, AILEEN (RBT)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10233 E NORTHWEST HWY STE 436
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-4418
Mailing Address - Country:US
Mailing Address - Phone:972-501-9917
Mailing Address - Fax:
Practice Address - Street 1:10233 E NORTHWEST HWY STE 436
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4418
Practice Address - Country:US
Practice Address - Phone:972-501-9917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician