Provider Demographics
NPI:1407011836
Name:WAITE, HAROLD
Entity Type:Individual
Prefix:MR
First Name:HAROLD
Middle Name:
Last Name:WAITE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:HAL
Other - Middle Name:
Other - Last Name:WAITE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:1626 WILCOX AVE
Mailing Address - Street 2:#170
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-6234
Mailing Address - Country:US
Mailing Address - Phone:323-855-0570
Mailing Address - Fax:
Practice Address - Street 1:7339 PYRAMID PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-1312
Practice Address - Country:US
Practice Address - Phone:323-855-0570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist