| Doctor Name: | AMADA N/A HERNANDEZ |
| NPI Number: | 1356646905 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | CAC III |
| License Number: | 7218 |
| Business Practice Address: | 711 Barnes Ave La Junta, CO - 810502138 |
| Business Phone Number: | 7193366931 |
| Business Fax Number: | 7193360478 |
| Mailing Address: | Po Box 4, BRISTOL |
| State: | CO |
| Postal Code: | 810470004 |
| Phone Number: | 7196911635 |
| Fax Number: | |
| NPI Enumeration Date: | 01/12/2011 |
| NPI Last Update Date: | 12/19/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 7218 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |