Provider Demographics
NPI:1699360537
Name:HERNANDEZ, JERRY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4615 VILLA NAVA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-6719
Mailing Address - Country:US
Mailing Address - Phone:210-364-4406
Mailing Address - Fax:
Practice Address - Street 1:4615 VILLA NAVA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6719
Practice Address - Country:US
Practice Address - Phone:210-364-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202689106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist