Provider Demographics
NPI:1942548714
Name:FERNANDEZ, MAYA S (LMHC)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:S
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 REGINA RD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87105-1530
Mailing Address - Country:US
Mailing Address - Phone:505-203-8631
Mailing Address - Fax:505-898-7288
Practice Address - Street 1:6666 4TH ST NW
Practice Address - Street 2:
Practice Address - City:LOS RANCHOS
Practice Address - State:NM
Practice Address - Zip Code:87107-6144
Practice Address - Country:US
Practice Address - Phone:505-230-8631
Practice Address - Fax:505-898-7288
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0154951101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor