Provider Demographics
NPI:1245740034
Name:HERNANDEZ, STEPHEN NICHOLAS (BCBA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NICHOLAS
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154
Mailing Address - Country:US
Mailing Address - Phone:469-673-8867
Mailing Address - Fax:214-230-7183
Practice Address - Street 1:102 BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154
Practice Address - Country:US
Practice Address - Phone:469-673-8867
Practice Address - Fax:214-230-7183
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-17-27718103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst