Individual
AMANDA HERNANDEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
33 NW BROADWAY, PORTLAND, OR 97209-3580
(971) 270-6280
Mailing address
1132 SW 13TH AVE, PORTLAND, OR 97205-1703
(971) 270-6280
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
103K00000X
Behavior Analyst
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1568401347
—
OR
Enumeration date
11/05/2013
Last updated
11/18/2020
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