Provider Demographics
NPI:1184497125
Name:HERNANDEZ, LAUREN P
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:P
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7601 QUAIL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-3538
Mailing Address - Country:US
Mailing Address - Phone:469-285-0206
Mailing Address - Fax:
Practice Address - Street 1:1701 RIVER RUN STE 805
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6553
Practice Address - Country:US
Practice Address - Phone:682-385-9540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
88972101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health