Provider Demographics
NPI:1679640288
Name:HERNBECK, LAURA CATHERINE (MS)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:CATHERINE
Last Name:HERNBECK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CATHY
Other - Middle Name:
Other - Last Name:HERNBECK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4555 TROUSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4513
Mailing Address - Country:US
Mailing Address - Phone:615-781-3000
Mailing Address - Fax:615-781-8262
Practice Address - Street 1:4555 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4513
Practice Address - Country:US
Practice Address - Phone:615-781-3000
Practice Address - Fax:615-781-8262
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11782101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4132025OtherBCBST