Provider Demographics
NPI:1003620576
Name:HERNANDEZ, HAILIE RENAE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:HAILIE
Middle Name:RENAE
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5015 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:KRUM
Mailing Address - State:TX
Mailing Address - Zip Code:76249-6030
Mailing Address - Country:US
Mailing Address - Phone:940-765-0753
Mailing Address - Fax:
Practice Address - Street 1:7551 CLEVELAND GIBBS RD BLDG 1
Practice Address - Street 2:
Practice Address - City:ARGYLE
Practice Address - State:TX
Practice Address - Zip Code:76226-4032
Practice Address - Country:US
Practice Address - Phone:940-319-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst