Provider Demographics
NPI:1477840890
Name:HAYSBERT, ALLEN (CATC)
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:HAYSBERT
Suffix:
Gender:M
Credentials:CATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 N CLAREMONT ST # 2
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-1825
Mailing Address - Country:US
Mailing Address - Phone:650-344-2867
Mailing Address - Fax:
Practice Address - Street 1:720 S B ST
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-579-7881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA200342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200342OtherCALIFORNIA ASSOCIATION OF ALCOHOL & DRUG EDUCATORS