Provider Demographics
NPI:1922581396
Name:HERNANDEZ, TAMARA ANN (CPC-I, MSCRMHC, BS)
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:CPC-I, MSCRMHC, BS
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:ANN
Other - Last Name:MULLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPC-I, MSCRMHC, ASDI
Mailing Address - Street 1:3960 E PATRICK LN STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-4902
Mailing Address - Country:US
Mailing Address - Phone:702-810-9927
Mailing Address - Fax:
Practice Address - Street 1:1040 JUNIPER RIDGE AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-6902
Practice Address - Country:US
Practice Address - Phone:702-809-7748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-12
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922581396OtherREGISTERED BEHAVIOR TECHNICIAN
MI1922581396Medicaid