Provider Demographics
NPI:1487898318
Name:JOHNELL FERNANDEZ
Entity type:Organization
Organization Name:JOHNELL FERNANDEZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:832-894-3576
Mailing Address - Street 1:3402 DOWLING ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77004-4271
Mailing Address - Country:US
Mailing Address - Phone:832-894-3576
Mailing Address - Fax:281-345-4599
Practice Address - Street 1:3402 DOWLING ST
Practice Address - Street 2:SUITE 260
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-4271
Practice Address - Country:US
Practice Address - Phone:832-894-3576
Practice Address - Fax:281-345-4599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
TX176300502251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176300502Medicaid
TX176300502OtherCMHC