Provider Demographics
NPI:1760561559
Name:HERNANDEZ, STACY M (MA LPC-MHSP)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MA LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3305 RED MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3594
Mailing Address - Country:US
Mailing Address - Phone:210-323-1978
Mailing Address - Fax:
Practice Address - Street 1:117 HUXLEY RD
Practice Address - Street 2:STE B3
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3179
Practice Address - Country:US
Practice Address - Phone:210-323-1978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2537101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional