Provider Demographics
NPI:1326360892
Name:HATHAWAY, IAN MCCLOUD
Entity Type:Individual
Prefix:PROF
First Name:IAN
Middle Name:MCCLOUD
Last Name:HATHAWAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W. RAMSEY ST.
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220
Mailing Address - Country:US
Mailing Address - Phone:951-492-5046
Mailing Address - Fax:
Practice Address - Street 1:3705 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3511
Practice Address - Country:US
Practice Address - Phone:760-288-4579
Practice Address - Fax:760-288-3752
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health