Provider Demographics
NPI:1295305290
Name:HERNANDEZ, EMILY ANN (LMHP, CMSW)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LMHP, CMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 W RAILWAY ST STE A114
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-3188
Mailing Address - Country:US
Mailing Address - Phone:308-635-2800
Mailing Address - Fax:308-633-2740
Practice Address - Street 1:115 W RAILWAY ST STE A114
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3188
Practice Address - Country:US
Practice Address - Phone:308-635-2800
Practice Address - Fax:308-633-2740
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-30
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
20421041C0700X
5676101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical