Provider Demographics
NPI:1841056132
Name:HERNANDEZ, ELIYAH (LCDC, LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ELIYAH
Middle Name:
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LCDC, LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:951 LEORA LN APT 538
Mailing Address - Street 2:
Mailing Address - City:THE COLONY
Mailing Address - State:TX
Mailing Address - Zip Code:75056-4028
Mailing Address - Country:US
Mailing Address - Phone:254-421-8455
Mailing Address - Fax:
Practice Address - Street 1:5440 HARVEST HILL RD STE 230
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-6424
Practice Address - Country:US
Practice Address - Phone:469-626-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91940101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health