Provider Demographics
NPI:1518526607
Name:THE CHILD AND FAMILY CONNECTION
Entity Type:Organization
Organization Name:THE CHILD AND FAMILY CONNECTION
Other - Org Name:DR. HAYLEY PEDERSEN
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAYLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, PSYD
Authorized Official - Phone:949-236-6155
Mailing Address - Street 1:151 KALMUS DR STE B150
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7955
Mailing Address - Country:US
Mailing Address - Phone:949-236-6155
Mailing Address - Fax:
Practice Address - Street 1:151 KALMUS DR STE B150
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7955
Practice Address - Country:US
Practice Address - Phone:949-236-6155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-12
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center