Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 6352000488 | MI |
NPI | 1013503291 |
---|---|
Provider Name | Adrian Josue Hernandez |
First Address | Grand Rapids, MI 49503-3900 |
Second Address | Grand Rapids, MI 49506-1214 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2020 |
Last Update Date | 12/12/2020 |