Provider Demographics
NPI:1659104248
Name:HERNANDEZ, GABRIELLE E
Entity type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:E
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 1:9815 NE 103RD ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-3345
Mailing Address - Country:US
Mailing Address - Phone:423-645-7597
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 20127
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97294-0127
Practice Address - Country:US
Practice Address - Phone:503-444-8214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling