Provider Demographics
NPI:1124116496
Name:HERNANDEZ, DINO M (LPC)
Entity type:Individual
Prefix:MR
First Name:DINO
Middle Name:M
Last Name:HERNANDEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2135 BABCOCK RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-614-7070
Mailing Address - Fax:210-615-0249
Practice Address - Street 1:2135 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4499
Practice Address - Country:US
Practice Address - Phone:210-614-7070
Practice Address - Fax:210-615-0249
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18564101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163464402Medicaid