Provider Demographics
NPI:1437565231
Name:HAYNES, KARLA (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90251-1045
Mailing Address - Country:US
Mailing Address - Phone:310-227-7424
Mailing Address - Fax:
Practice Address - Street 1:12099 W. WASHINGTON BLVD.
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4303
Practice Address - Country:US
Practice Address - Phone:310-227-7424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#78472101YM0800X
CAIMF 78472106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health