Provider Demographics
NPI:1275231300
Name:JOAN HASIBAR MARRIAGE AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:JOAN HASIBAR MARRIAGE AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HASIBAR
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:323-985-8782
Mailing Address - Street 1:49 S BALDWIN AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91024-2580
Mailing Address - Country:US
Mailing Address - Phone:323-985-8782
Mailing Address - Fax:
Practice Address - Street 1:49 S BALDWIN AVE STE D
Practice Address - Street 2:
Practice Address - City:SIERRA MADRE
Practice Address - State:CA
Practice Address - Zip Code:91024-2580
Practice Address - Country:US
Practice Address - Phone:323-985-8782
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669925343OtherJOAN HASIBAR MA LMFT110956