Provider Demographics
NPI:1609434356
Name:HAILEY, NEAL (LMFT #123912)
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:HAILEY
Suffix:
Gender:M
Credentials:LMFT #123912
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7033 THORNHILL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1338
Mailing Address - Country:US
Mailing Address - Phone:415-519-3870
Mailing Address - Fax:
Practice Address - Street 1:7033 THORNHILL DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1338
Practice Address - Country:US
Practice Address - Phone:415-938-7051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-29
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty