Provider Demographics
NPI:1265647770
Name:HAYNES PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:HAYNES PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-665-3333
Mailing Address - Street 1:17632 IRVINE BLVD
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3148
Mailing Address - Country:US
Mailing Address - Phone:714-665-3333
Mailing Address - Fax:
Practice Address - Street 1:17632 IRVINE BLVD
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3148
Practice Address - Country:US
Practice Address - Phone:714-665-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health