Provider Demographics
NPI:1790791499
Name:HERNANDEZ, FRED Z JR (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:FRED
Middle Name:Z
Last Name:HERNANDEZ
Suffix:JR
Gender:M
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W COMMERCE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3839
Mailing Address - Country:US
Mailing Address - Phone:210-227-2707
Mailing Address - Fax:210-225-7751
Practice Address - Street 1:2300 W COMMERCE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3839
Practice Address - Country:US
Practice Address - Phone:210-227-2707
Practice Address - Fax:210-225-7751
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7398101YP2500X
TX4110106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155788601Medicaid