Provider Demographics
NPI:1699355768
Name:HERNANDEZ, MAIRA M (LMFT)
Entity Type:Individual
Prefix:
First Name:MAIRA
Middle Name:M
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 1:1187 N WILLOW AVE # 103-880
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-4411
Mailing Address - Country:US
Mailing Address - Phone:559-241-8085
Mailing Address - Fax:559-702-6101
Practice Address - Street 1:5151 N PALM AVE STE 200
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2221
Practice Address - Country:US
Practice Address - Phone:559-241-8085
Practice Address - Fax:559-702-6101
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99813106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9272042Medicaid