Provider Demographics
NPI:1518401520
Name:HERNANDEZ, EVONNE
Entity type:Individual
Prefix:
First Name:EVONNE
Middle Name:
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 1:1 BREAKTHROUGH WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-3011
Mailing Address - Country:US
Mailing Address - Phone:702-802-2851
Mailing Address - Fax:
Practice Address - Street 1:1 BREAKTHROUGH WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-3011
Practice Address - Country:US
Practice Address - Phone:702-802-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-09
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor