Provider Demographics
NPI:1811650930
Name:HERNANDEZ, RUYMAN DAVID (LMHC)
Entity type:Individual
Prefix:
First Name:RUYMAN
Middle Name:DAVID
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 903
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-0903
Mailing Address - Country:US
Mailing Address - Phone:360-524-1469
Mailing Address - Fax:
Practice Address - Street 1:1633 SW KELLY AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-3822
Practice Address - Country:US
Practice Address - Phone:360-524-1469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-15
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61210868101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health