Provider Demographics
NPI:1801228887
Name:HERNANDEZ, JENNIFER M (TLMFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:TLMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 E 22ND ST N
Mailing Address - Street 2:BUILDING 800, SUITE 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67226-2388
Mailing Address - Country:US
Mailing Address - Phone:316-683-4083
Mailing Address - Fax:316-689-8431
Practice Address - Street 1:8100 E 22ND ST N
Practice Address - Street 2:BUILDING 800, SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-2388
Practice Address - Country:US
Practice Address - Phone:316-683-4083
Practice Address - Fax:316-689-8431
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2496106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist