Provider Demographics
NPI:1083130132
Name:HATFIELD, KEZIA A (LMFT)
Entity Type:Individual
Prefix:
First Name:KEZIA
Middle Name:A
Last Name:HATFIELD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 NEVADA ST STE B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4222
Mailing Address - Country:US
Mailing Address - Phone:530-710-8037
Mailing Address - Fax:951-848-6277
Practice Address - Street 1:12 NEVADA ST STE B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:530-710-8037
Practice Address - Fax:951-848-6277
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100698OtherLMFT