Provider Demographics
NPI:1104203975
Name:HAGLE, HEIDI ALEXANDRA (MA MFTI)
Entity Type:Individual
Prefix:MISS
First Name:HEIDI
Middle Name:ALEXANDRA
Last Name:HAGLE
Suffix:
Gender:F
Credentials:MA MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 WESTPARK CT UNIT 405
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-8444
Mailing Address - Country:US
Mailing Address - Phone:805-504-6777
Mailing Address - Fax:
Practice Address - Street 1:209 WESTPARK CT UNIT 405
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-8444
Practice Address - Country:US
Practice Address - Phone:805-504-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF85966101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health