Provider Demographics
NPI:1962179341
Name:HERNANDEZ, NATASHA B (PHD)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:B
Last Name:HERNANDEZ
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 BRIDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75054-7244
Mailing Address - Country:US
Mailing Address - Phone:682-333-2150
Mailing Address - Fax:
Practice Address - Street 1:2680 BRIDGEWATER DR
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75054-7244
Practice Address - Country:US
Practice Address - Phone:682-333-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX40275103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor