Provider Demographics
NPI:1194240192
Name:FERNANDEZ, FEBE SARAI (MA, LPC)
Entity type:Individual
Prefix:
First Name:FEBE
Middle Name:SARAI
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MA, LPC
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 34477
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78265-4477
Mailing Address - Country:US
Mailing Address - Phone:512-537-4065
Mailing Address - Fax:512-539-2881
Practice Address - Street 1:12702 TOEPPERWEIN RD STE 215
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3250
Practice Address - Country:US
Practice Address - Phone:512-537-4065
Practice Address - Fax:512-539-2881
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-10
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75178101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX412180801Medicaid
TX1194492983OtherNPI 2