Provider Demographics
NPI:1720809106
Name:HERNANDEZ, MELODY MELINDA
Entity type:Individual
Prefix:
First Name:MELODY
Middle Name:MELINDA
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1133 RIVER WOOD
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-0083
Mailing Address - Country:US
Mailing Address - Phone:951-818-4421
Mailing Address - Fax:
Practice Address - Street 1:1133 RIVER WOOD
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-0083
Practice Address - Country:US
Practice Address - Phone:951-818-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC17536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist