Provider Demographics
NPI:1255008173
Name:JAMELELLAIL, HAYA
Entity Type:Individual
Prefix:
First Name:HAYA
Middle Name:
Last Name:JAMELELLAIL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17724 HALSTED ST # A
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2025
Mailing Address - Country:US
Mailing Address - Phone:818-450-7992
Mailing Address - Fax:
Practice Address - Street 1:17724 HALSTED ST # A
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-2025
Practice Address - Country:US
Practice Address - Phone:818-450-7992
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-27
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health