Provider Demographics
NPI:1407370612
Name:HERNANDEZ, JACQUELINE A (LPC-S)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:A
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1811 S LAREDO ST STE 111
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-7019
Mailing Address - Country:US
Mailing Address - Phone:210-324-0658
Mailing Address - Fax:
Practice Address - Street 1:1811 S LAREDO ST STE 111
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7019
Practice Address - Country:US
Practice Address - Phone:210-744-4828
Practice Address - Fax:210-229-8973
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-29
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health