Individual ProviderTamara Ann HernandezCounselorBehavioral Health & Social Service ProvidersPractice Address1040 Juniper Ridge Ave, Henderson, NV 89015-6902(702) 809-7748(702) 810-9927PECOS EnrollmentBased on the most recent information from CMS, provider Tamara Ann Hernandez does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 4 days ago.Profile DetailsProvider ID1922581396Provider TypeIndividualFull NameHernandez, Tamara AnnTitleMrs.CredentialCPC-I, MSCRMHC, BSGenderFemaleSole ProprietorYesEnumeration Date9/12/2018Last Updated2/28/2024Contact InformationPractice LocationPractice Address1040 Juniper Ridge Ave, Henderson, NV 89015-6902Phone(702) 809-7748FaxUnlisted FaxMailing LocationMailing Address3960 E Patrick Ln Ste 202, Las Vegas, NV 89120-4902Phone(702) 810-9927FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode106S00000XDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID1922581396DescriptionOtherIssuerREGISTERED BEHAVIOR TECHNICIANMichiganID1922581396DescriptionMedicaidIssuerUnlistedMichigan