Provider Demographics
NPI:1922183409
Name:HERNANDEZ, JUAN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78551-0249
Mailing Address - Country:US
Mailing Address - Phone:956-412-7500
Mailing Address - Fax:956-412-7509
Practice Address - Street 1:310 E VAN BUREN AVE
Practice Address - Street 2:SUITE 123
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-6815
Practice Address - Country:US
Practice Address - Phone:956-412-7500
Practice Address - Fax:956-412-7509
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11723101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX028678303Medicaid